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-•-.-"s' <br />110 and 111 Enclosure <br />l <br />permittee Name: Holly Sugar Corp ' <br />Permit No: M-17-303- ~ ,~, ~,; . ~ ,~ #~ <br />Operation Name: Rex Quarry ( ~{~~„~. <br />Anniversary Date: O:i / U1 / 85 - , <br />h. ~ .~~~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />J/ Annual Report <br />Remarks: ~3.~C ~ ~f~-~ / ~ ~ ~~ ~ ~f---r-' <br /> <br />SiQnatu <br />