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<br />• ~~~ II~IIIII~II~~ II~ <br />ssa <br />Permittee Name: <br /> <br />BB 111 /11KK1l2pE~ncl osure <br />Permit No: Miller - Berends Company APR 15 1987 <br />Operation Name: M-82-112 <br />Anni versary Date: Mi 11 er Gravel Pi t MINt'D LAND <br />03/11 /87 DECLAMATION DIVI31ON <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 /> <br />(Rev. 02/87) <br />5257E <br />~/ ( 5n ,~8 R7 p2 <br />n -9~-0~0 <br />~i- ~~ <br />