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.. <br />110 Enclosure <br />Permittee Name: Mitchell Concrete E Caisson Dr <br />Permit No: M-86-026 <br />Operation Name: Freeman 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 cd2 ..0/zrc%~i /Za~~~, ll~,tt ~ ~~~ <br />~lsy d~/6/8~ <br />Remarks: 0 <br />~"`~'~"~, aPo <br />Signature LIAR „~ 1908 <br />(Rev. 02/87) tti.~~rQ ~~`~~ <br />5257E IiLCLA~~~.'!'~Oi~ L1lVt"ICli~~ <br />