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--~ <br />+ ~II ~I~~I~~I~~~~~ II~ <br />999 <br />Q 11 ~~~closure <br />~`~~,~ <br />Permittee Name: Builders Aggr Co Inc 1 6 <br />Permit No: M-81-112- ~~+t' <br />AnniversaryaDate: 09I~DEDRS/A85R PIT MMA O p ~SSipP1 <br />RgC,V~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclose are: (Check space(s) be Tow) - -- <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />y Annual Report <br /> <br />6~° <br />~,ti <br />~1 <br />nature j y~~, ~ <br />