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<br /> <br />111/112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Cooley Gravel Co <br />M-74-041 <br />Lawrence Pit <br />01/29/88 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclgsed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />/Division for annual fees due <br />f/ Annual Report <br />Map _ <br />/~~ •' ~cV~n ~~er~e r <br />Remarks: ~e-r~u >~~ /r.~hess ,~,~~7P.c~P>~I y . <br /> <br />-i~a/. <br />Signature <br />(Rev. 02/87) <br />5257E <br />