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', ~~~~ • i III IIIIIIIIIIIIIIII <br />999 <br />', 112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Please complete t <br />reclamation data. <br />Colorado Lien Co <br />M-77-302- <br />OWL CANYON QUARRY <br />10! 27!85 <br />he following and return this form with your fees and <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: Report to follow. <br />~, <br />S i~fi'ature <br />