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T <br />o~ ~+ • • <br />110 and 111 Enclosure <br />Permittee Name: Dick Casey Concr Inc <br />Permit No: M-78-349- <br />Operation Name: DICK CASEY CONCR PIT <br />Anniversary Date: 12 / ZO / 85 <br />Please complete the following and return this form with your fees and <br />reclamation data. <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 <br />Remarks: we will sincerly try to Ret the Notice of Intent to Cnn tinne <br />Ptining Operations (Annual Report) to you by 1/30/86 <br />Siahature <br />