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110 and 111 Attachment <br />Permittee Name: Builders Aggregate Co., Inc. <br />Operation Name: BUILDERS AGGREGATE PIT <br />Permit Na: 81-112 <br />Anniversary Date: September 1 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Chock box(es)) <br />I_I Check or money order payable to Colorado Mined land <br />Reclamation Division for annual fees due <br />_,I Annual Report <br />Remarks: <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1182 <br />