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/ _ <br />-^ : ~_,._ ~ III IIIIIIIIIIIIIIII ~~ ~~~~~® <br />,a 12 1 ~ ~,~~~.~ <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Total: <br />Central Aggregates, <br />M-81-006 <br />West Rifle Pit <br />04/27/90 <br />5350.00 (Due on <br />- .J,INEDLAf:.: 111/112 Enclosure <br />C1kCl ~1MA?!ON Oi~~• i;~ <br />Inc. <br />the Anniversary Date) <br />Please return this form with your completed Annual Report, map, and a <br />check or money order for annual fees due, payable to the Colorado t•lined Land <br />Reclamation Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. <br />ANNUAL REPORT: <br />See Attached <br />Signature <br /> <br />