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<br />112 Attachment <br />Permittee Name: <br />Operation Name: <br />Permit No: <br />Anniversary Date: <br /> <br />Brannan Sand & Gravel Co <br />~;r~~9 <br />80-183 <br />January 8 <br />Please complete the following and return this form with your. fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I~ Annual Report <br />I v1~ Map <br />Remarks: <br />Signature <br />(Rev. 5/84) <br />Dac. No. 1805 <br />