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<br /> <br />111/112 Enclosure <br />Permittee Name: <br />Permit No: Colorado Lien. Co ' <br />Operation Name: M-77-301 <br />Anniversary Date: Roberts Quarry <br />10/27/87 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclam~ition <br />Division for annual fees due <br />~, Annual Report <br />Map <br />Remarks: <br /> <br />OCT 2 21981 <br />MINED LAN! <br />RECLAMATfQN %Jty4:!()y1 <br />Signature ` <br />(Rev. 02/87) <br />5257E <br />