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.. ~ . III III III III I'll III . <br />110 and 111 Enclosure <br />Permittee Name: Mobile Premix Co <br />Permit No: M-77-057- <br />Operation Name: FEDINEC PIT <br />Anniversary Date: 11 / 22 ! 85 <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 due <br />Annual Report <br />Remarks: <br />Signature <br />