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<br />.- <br />112 Enclosure <br />Permittee Name: Lakewood Brick and Tile Co. <br />Permit No: M-79-045 <br />Operation Name: Church Pit <br />Anniversary Date: 02 / ~8 / 90 <br />Please complete the following and return this form with your fees <br />and reclamation data. <br />Enclosed are: Check space(s) below <br />X2L Check or money order payable to Colorado Mined Land Reclama- <br />tion Division for annual fees due <br />~_ Annual Report <br />_X7L i"~P <br />Remarks: <br />Sigy[~a'ture James` Murray, President <br />