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~ ~ III IIIIIIIIIIIII III` <br />RC ~~'~~rp112 Enclosure <br />P~~rmittee Name: COOLEY GRAVEL CO AUK 1 2 X185. <br />Permit No: M-73-021- MINEDLgND <br />Al~niversaryaDate: 05R~I~ON Q85RRY REC~MATIpNpIyISIpN <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 for annual fees due <br />X Annual Report <br />X Map <br />Remarks: The annual fee was submitted under sep,grate cover- A <br />- copy of the check is included in this report as a record of <br />ent for varification. <br />`,signature <br />