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<br /> <br />i ~- <br /> 112 Enclosure <br />Permittee Name ~ ~~ ~~ ~ D <br />: Dakolios Construction Co. <br />Permit No: <br />ti <br />N <br />O M-84-036 SAN 21 ~g g <br />on <br />ame: <br />pera pit #1 <br />Anniversary Date: April 3o EA-NED LA ~ <br /> RECLAMATION IVISION <br />Please complete the following and return this form with your fees an <br />reclamation data. <br /> 7 Yo <br />Enclosed are: (Check space(s) below) <br />x Check or money order payable to Colorado Mined Land Recla~ation <br />Division for annual fees due <br />Annual Report <br />k Map <br />Remarks: <br /> <br />Signature <br />