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-~. iii iiiiiiiiiiiiiiii <br />999 <br />Permittee Name: Mathias Concrete In~ <br />Permit No: M-77-140 <br />Operation Name: N Farm Rd Pit No 1 <br />Anniversary Date: 01/15/88 <br /> <br />~~~/112 ure <br />JAN 21'11988 <br />MINED LAND <br />RECLAMATION DIVISION <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: ( 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 /> <br />(Rev. 02/87) <br />5257E <br />wd ~~ <br />\~~~~~ <br />w- <br />