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<br />111/112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Cooley Gravel Co <br />M-76-009HR <br />Menzer Quarry <br />06/23/87 <br />Please complete the following and return this form with your fees rind <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />C Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~c Annual Report <br />~( Map <br />Remarks: <br /> <br />Signature <br />(Rev. 02/87) <br />5257E <br />