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.. <br />112 Attachment <br />Permittee Name: Flintkote Comnanv <br />Operation Name: <br />Permit No: 77_287 <br />Anniversary Date: ~r;l 7R <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I~I Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />ICI Annual Report <br />~~ Map <br />Remarks: <br />(Rev. 5/84) <br />Doc. No. 1805 <br />