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=- ~ ~ iii iiiiii~iiiiiiiii • <br />999 <br />110 and 111 Attachment <br />Permittee Name: Southwest Readv-Mix Inc <br />'i Operation Name: ~wif merit (Ala. Pit No. zi <br />Permit No: 83-175 <br />Anniversary Date: November 7.5 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~- Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~-~ Annual Report <br />Remarks: Ann ,a~ rPnn,-i- rn fnllnw <br />Signature Izora L. Southway, Vice Pres. <br />(Rev. 5/84) <br />Doc. No. 1782 <br />