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<br />Corn Construction Co <br />M-78-323- <br />WEBB PIT <br />11 / 22 / 85 <br />110 and 111 Enclosure <br />~ Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />5~~ i3~lo.~ Annual Report <br />Remarks: N'= ~'^""/ his -f~k~~ Place ~.-r~"`/ -jhe~as~~~errt onl~5}o<kp;le <br />h2.~< b.~~ 1~_~~~a. <br /> <br /> <br />MINED LAND R`-4MATION DIVISION N ~ ~ 5 013 <br />1313 Sherman-street Room 423 <br />Denver. CO SOZ03 ~ DATE /~~rrll 2 ~ ~B SS <br />(30/3^), 566-3567 /~ !~ <br />RECEIVED FROM \ /T2 /~'1 ` Y5~7111 Jl A Tl ICY] Cf-7 <br />~~~ ~ 1 <br />THE SUM OF~~}ai ~+' '/SrT"'~'~- DOLLARS $ J~ •~~~ <br />~J ~ ^cns. <br />FOR ~ M ~ m-"7~- 3a3 '/3rj 102 pMOCK <br />AMOUNT OF ACCOUNT...... $ <br />AMOUNT PAID .............. . $ <br />BALANCE DUE ............... $ <br />,y'~1 ~~anl~~~(~o, ul <br />By 7 \ - ~(J U/li~./ <br /> <br />Signature <br />