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<br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Dotsero Block, Inc. <br />M-87-074 <br />Dotsero Quarry <br />10 / u9 / 89 <br />Please complete the following and return this form with your fees <br />and reclamation data. <br />Enclosed are: Check space(s) below <br />X~ <br />Check or money order payable to Colorado Mined Land Reclama- <br />tion Division for annual fees due <br />Annual Report <br />Map <br />Remarks: <br /> <br />ture Robert E. <br />tman, <br />