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~ ~1 <br />• <br />111/112 Enclosure <br />Permittee Name: Robinson Brick Co <br />Permit No: M-81-148 ~ 35 ~ <br />Operation Name: Chieftain South Mine CrK I c7 ~~) ~ <br />Anniversary Date: 11 / O1 / 86 <br />~~.~~~o <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Encl~,o/sed are: (Check space(s) below) - -- <br />y.~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: <br />Signature <br />