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~ III IIIIIIIIIIIII III • <br />~I ~.;' VtiA' yw~ N _ 111 /112 Enclosure <br />;'~:'T 81981 <br />Permittee Name: Dorn Ready-Mix Corp <br />Permit No: AnINFD ~,:... <br />Operation Name: M-74-092 ~ECLAMP.T'IUN DIVISION <br />Anniversary Dategarlow Pit <br />?0/31/87 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />r~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks:(~,~~ tJ~~/.<a~l~- l <br />(Rev. 02/87) <br />5257E <br />