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IlllllllllllllllZII j <br />• <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Colorado Lien Co <br />M-85-038- <br />Rifle Quarry <br />09/26/86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Annual Report to Folloca <br />Remarks: <br />_, ..,, ` <br />~. <br />~J` <br />..~. .. <br />:~, <br />~Cn <br />gnature <br />f (~a-l ~ ~N~ <br />~: ~ <br />f <br /> <br />