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<br /> <br />d <br />Signature <br />• ~ iii iiiiiiiiiiiuiii <br />~~ <br />110 and 111 Attachment <br />Permittee Name: Art's Fertilizer Co., Inc. <br />Operation Name: <br />Permit No: 80-205 <br />Anniversary Date: October 2 <br />RECEIVED <br />OCT 0 9 1984 <br />I.41NED LAND RECLAMATION DIVISION <br />Colo. Dept. of Natural Resources <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 />I_I Annual Report <br />4 <br />s. <br />(Rev. 5/84) <br />Doc. No. 1782 <br />