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- . • , iii iiiiiiiiiiiii iii . ; <br />~~~ <br />~~ <br />110 and 111 Attachment r~ <br />~,, <br />Permittee Name: Andersen Construction Co. ~~ <br />Operation Name: R~IrE~VE~ <br />Permit No: 77-53 <br />dEC 1 `~ 19Q4 <br />Anniversary Date: December 23 <br />MINED LAND RECLAMATION DIVISION <br />Colo. Dept of Natural Resources <br />?]ease complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />y~ Check or money order payab]e to Colorado Mined land <br />Reclamation Division for annual fees due <br />I_I Annual Report <br />Remarks: ~Y1.7 n . ~ <br /> <br />~ ~ % <br />Signature ra~/~/~~ <br />(Rev. 5/84) <br />Doc. No. 1782 <br /> <br />