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.. <br /> <br />112 Attachment <br />Permittee Name: Hard Pock Paving <br />Operation Name: Hart Rok Main Plant <br />Permit No: ~/-lg~ <br />Anniversary Date: April 21 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I~Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I_I Annual Report <br />I_I Map <br />Signatu~ <br />(Rev. 5/84) <br />Doc. No. 1805 <br />