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• <br />111/112 Enclosure <br />> -._ ,~-. <br />Permittee Name: Denver Brick Co ^~~~ ~,`~. ; <br />M-77-39? -~- ~`- <br />Permit No: Dawson State Lease I,iAR n <br />_.: Operation Name: 03/11/88 3 1988 <br />_ Anniversary Date: A:f~~l"J f .(~, <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />XX Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />XX Annual Report <br />XX Map <br />Remarks: <br />`/'~c <br />Signature Michael D. Stanton <br />(Rev. 02/87) Consultant to <br />5257E The Denver Brick Company <br />