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<br /> <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />u <br />111/112 Enclosure <br /> <br />Valco Inc <br />M-77-560 <br />Rocky Ford East Pit <br />02/22/87 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />/ Gheck or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />/ Annual Report <br />Map <br />Remarks: <br />,~~~ <br />Signature <br />.nr .J~~ <br />~ ~. <br />~7/ •~. J <br />