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III IIIIIIIIIIIII III <br /> <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />• <br />Dorn Ready-mix Corp <br />M-74-092- <br />BARLOW PIT <br />09/16/85 <br />~~~ ~~ - <br />.~ ,112 Encl u~S re <br />SFp ,~ <br />' LU~~ <br />~'~~i MarroN ~~°s, <br />~~. 1 <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 />X Annual Report <br />~ Map <br />Remarks <br />9p .,, <br />~, i.l:.Ze_1 - f6rir ri -(• ~~ ~T o :....~/ iIi ~c~ a?~ ~ ~ ..1 ~C -a <br />ar' cis vY .[,..~.~ _-~:,. ~ ~~.._~.~ ~ -9 ~ ` - -.. <br />GQ~- L :. E~J._ , ~~~1/. G o-r-.~ ~ c , ~ :... is rim <br /> <br />S <br />