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<br /> <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br /> <br />Corn Construction Co <br />M-79-002- <br />NORTH DELTA PIT <br />04 / 11 / 86 <br />112 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined <br />Land Reclamation Division for annual fees due <br />S« Rel~«+ Annual Report <br />Map <br />Remarks: <br />rc.-,ev<<~ tVo ~~~~..9 w.as ~i~~~ d~r~.,r, the <br />~F-o ~-. ~+r precr ss~..S si ~c pa~~ ye, r. Sl~rkp,l~s wrr~ <br />/Vc~ ~.n.~rr~ i~5 r,~p« ~r~ '~'c ccc u! f~ii ~5 ~~r~r. <br />Signature <br />9-~ -~~ <br />`t`/ll~S6 <br />°r'' ~,~ <br />~~Q <br />pPR 10196 <br />MMIEO lAa'~~~p~p~i <br />Cd0• D~~ <br />