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-W111111 <br /> 999 <br /> 110 Enclosure <br /> Permittee Name: Persolite Products <br /> Permit No: M-77-319 <br /> Operation Name: Swallow Perlite Mine <br /> Anniversary Date: 11/22/88 <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 Reclamation -- <br /> Division for annual fees dueE <br /> Annual Report <br /> Remarks: <br /> Signature <br /> (Rev. 06/88) RECEIVED0052f <br /> NOV 16 1988 <br /> MINED LAND <br /> RECLAMATION DlVV6+3ioN <br />