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<br />' • <br /> <br />112 Enclosure <br />Permittee Name: Butala Const Co <br />Permit No: M-77-170- <br />Operation Name: BUTALA GRAVEL PIT <br />Anniversary Date: 10 / O1 / 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 />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~_ Annual Report <br />x Map <br />Remarks: <br />ACT f .. ~ ~~~ <br />,TFC ,`~~N~ ,~S <br />~M~T iOO~~~ .S <br />~Oy <br />ignature <br />