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<br /> <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Robinson Brick Co <br />M-77-252- <br />PIONEER MINE <br />O1 / 13 / 86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are <br /> <br />x <br /> <br />Remarks: <br />Check or money order payable to Colorado Mined <br />Land Reclamation Division for annual fees due <br />Annual Report <br />Map <br />(Check space(s) belowl <br />Signature <br />