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112 Attachment <br /> Permittee Name• Ideal Basic Industries, Inc. <br /> Operation Name: Portland Limestone quarry <br /> Permit No: M-77-344 <br /> Anniversary Date: 10 / 10 / 188 <br /> Please complete the following and return this form with your fees and <br /> reclamation data. <br /> Enclosed are: (Check box(es) ) <br /> IX I Check or money order payable to Colorado Mined Land <br /> Reclamation Division for annual fees due <br /> $350.00 <br /> IX I Annual Report <br /> Ix I Map <br /> Remarks• <br /> Signature <br /> (Rev. 5/84) - <br /> Doc. No. 1805 <br />