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<br /> <br />111/112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Avery Const Co Inc <br />M-79-010 <br />Avery Const Pit <br />O1 /15/87 <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 fer annual fees Aue <br />x Annual Report <br />Map <br />Remarks: <br />F E [3 0 51987 <br />MINED LAND <br />RECLAMA74ON D4VIS1O4~4 <br /> <br />$igndture Richard C. <br />