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• <br />rermiccee name: Hvery ~trUCtures, lnc. <br />Operation Name: <br />Permit No: 79-10 <br />Anniversary Date: January 15 _ <br /> <br />112 Attachment <br />,.•_ <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 />Map <br />Remarks: <br />RECEIVED <br />JAN 1 S 1985 <br />MINED LAND RECLAMATION DIVISIOII <br />Calo. Dept. of Natural Resources <br /> <br />Signature <br />(Rev. 5/34) <br />Doc. No. 1805 <br /> <br />