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<br />~ r III IIIIIIIIIIIII III <br />Permittee Name: Ready Mix Concrete <br />Operation Name: PIT N0. I <br />Permit No: 77-436 <br />Anniversary Date: August 23 <br />• ~ ,%,~ <br />112 Attachment <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I~ <br />I~~ <br />I~I <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />RECEIVED <br />Annual Report <br />AUG 2U Iyb4 <br />MINED LAND RECLA~NATION DIVISIOPI <br />Colo. Dept. of Natural Resources <br />Map <br />Remarks: Refer to the attached reoo~t and mav. <br />(Rev. 5/84) <br />Doc. No. 1805 <br />