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~ 112 Enclosure <br />Permittee Name: Andersen Construction Co ~q~ <br />Permit Nn: M-80-156 <br />Operation Name: Midway Gravel Pit S O CT 2 ° 1986 <br />Annivers~iry Date: 10 / 15 / 86 <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 far annual fees due <br />~_ Annual Report <br />_~ Map <br />Remarks: <br />