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III IIIIIIIIIIIIIIII ~ ~ <br /> <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Dorn Ready-Mix Corp. <br />td-74-092 <br />Barlow Pit <br />10/31 /88 <br />111/112 Enclosure <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 <br />Annual Report <br />Map <br />Remarks: <br /> <br />/~ <br />h~ o <br />S g ture ' <br />(06/88) <br />0054f <br />