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• <br />~ iii iiiiiiiiiiiu iii <br />999 <br />110 Enclosure <br />Permittee Name: Mitchell Concrete & Caisson Dr <br />Permit No: M-86-025 <br />Operation Name: Mitchell Mine No. 1 <br />Anniversary Date: 03/19/88 <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 />Remarks: (y e. hao ./ ~~ iru ~n/i~.s%~, n,9i .z~fcfo 0~.,-,~v. <br />Sigfiature <br />(Rev. 02/87) <br />5257E <br /> <br />;L'O <br />n'~ <br />