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a. ~- _ N ~ III IIIIIIIIIIIII III <br />110 and 111 Enclosure <br />-_ Enclosed are: (Check space(s)-below) <br />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~ Annual Report ~~~~ ~,Y I 1 JiJ! <br />.., <br /> <br />Permittee Name: TEZAK CONST CO INC <br />Permit No: M-81-080- <br />Operation Name: TEZAK NO 2 PIT <br />Anniversary Date: 05 / 27 / 85 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />1~;~- ' .. <br /> <br /> <br />Signature <br />S~ISI~S <br />OYvt . ¢~ " U <br />