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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />110 and 111 Enclosure <br />• <br />Hillco Rock Inc <br />M-82-O11- <br />HILLCO ROCK PIT <br />06/24/86 <br />• <br />C } <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 />_~L Annual P,eport <br />Remarks: <br />JL <br />-9 tiP~ i~E~l w,nyRTlun/ r3~ti~~i. T Aw~a C~AI_Lp.D fli.w~ S~eUer~nL <br />T.~w.~5 TRviurr T~,L.e2A~ NinM cL~T ~„rn-2 l,Ei,~/itii WLL in.~ oltAel' <br />i5v?1,.c He„r.i~,F;sarv D~aTe.~f~ueti~( p~~a.P Do tic~T ~Zeircl:.R OUJ' <br />1~er..,-,~T ~T c~~l_L ~SQTraxe,~, P.~aa~ ter: <br />A~a~. ~ r~)Revr i.s 1'e ~~ lI~SR~A~~ <br />7 <br />Signature <br /> <br />'JUN 191986 <br />;~ <br />61~~~ <br />~,".~•~ <br />~'s /~' <br />