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<br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Asphalt Gravel Prod <br />M-78-271 <br />Garrett Pit <br />10/30/86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due ~Srnr e.~~aaaDaJ <br />Annual Report <br />X Map <br />Remarks: ~~c~d'nti- n..r,-..e,r-a,(. 4.V_ n Q[Fl~.vi ,rr~~`.,~c~Pi A~zrn.- a-~C` ,bs.~P_aJ <br />"~~d '--L~ r ,7 <br />2i!.4LatL~ ~Pi/.t.o tt.uen-cntJ .7~Ji ~.^~~~- ~iDn.[J Sfn~ Y.~[[m. /Yte (/~in,~.~ acJ /'.,tm l1_i p~tvi <br />,2tt~»'nl.~4.Q~ /i+v lFnm . 19A~ u/l a. ir1r Al n'La~ P,~~r.~, yn~ .7~.. ~r~- iin. /98(~ . <br />~/poYs. i~n..eJ `ltl~'it ltnv ~/i/~'~1/ nnn Ow rrr n~«*>,/ trn/ .7~1. I~Pw P~..Y uQA. .{isnt~j/~.`XJ <br />Ytir ~. Rnr~P/ rn,.~, lr B'ha ~l~.~-e%/!mA nrH/C/ ~n/R[ ~ !Ui /•-rwt n. /~Fi~![/ <br />~ .ss-- J~ r -~ <br />h0/~,fn,/ M~': /I ~nfan/~rt fl'i~ <br />gnature <br />