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<br />"~'E~~'ll~ll'1~2 Enclosure <br />Permittee Name: Asphalt Paving Co ~V 2 5 ~98j <br />Permit No: M-83-089 <br />Operation Name: Tomah Site RECf.gH11AT~~pLAfVD <br />Anniversary Date: 11 / 08 / 86 N DIVfSIp-y <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />x Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />x Annual Report <br />x Map <br />Remarks: See attached report <br />n <br />_ ., S9gnature <br />