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<br /> <br />110 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 / 20 / 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 />X Annual Report <br />Remarks: <br />Signature <br />