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'• y • • III III III III IIII III <br />110 Enclosure <br />~, <br />r~~ i -, I <br />Permittee Name: Hard Rock Paving 6 Redi-Mix <br />Permit No: M-77-197 <br />Operation Name: Hart Rok Main Gravel ~ ~., ~ >, <br />Anniversary Date: 04/21/88 ~~ 1, <br />,~ ~'' B <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 pdyable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />x Annual Report <br />Remarks: <br />Signature <br />7297G <br />0052f ~L~~1 <br />~O <br />., i <br />