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<br /> <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Ready Mix Concrete <br />M-77-436- <br />Rec Project No 1 <br />08/28/86 <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 />- ( Map <br />Remarks: <br />-i. i ~tr~r-~wu~ <br />gna e <br />