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~~ <br /> <br />~ ~ III IIIIIIIIilllllll <br />~~~~~~ <br />- 111/112 Enclosure <br />t~PR 18 '~~~~ <br />Permittee Name: Webster Sand & Gravel RAINED LI~ivU <br />Permi t No: M-81-235 REGL~.MATIOIJ Qlvl~!!~P: <br />Operation Name; West Tennessee <br />Anniversary Date: 04/22190 <br />Total: 5350.00 (Due on the Anniversary Date) <br />Please return this form with your completed Annual Report, map, and a <br />check or money order for annual fees due, payable to the Colorado Mined Land <br />Reclamation Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. <br />ANNUAL REPORT: <br />~' ~~~~ <br />Signature <br />~~`'~ <br />~~ a~ <br />R~ <br />