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~' <br />Permittee Name: Valco <br />Permit No: M-81-014 <br />Operation Name: Rozman Pit <br />Anniversary Date: 06/29/87 <br />+ ~~ 1V C D/112 Enclosure <br />EJUL 219616 <br />MINED LAND <br />RECLAMATION DIVISION <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />l/ 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 />(Rev. 02/87) <br />5257E <br />