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<br /> <br /> <br />112 Enclosure <br />Permittee Name: <br />Permit Mo: <br />Operation Name: <br />Anniversary Date <br />Brannan S & G Co <br />M-80-183- <br />PIT 29 <br />O1 / 08 / 86 <br />Please compiete 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 <br />Land Reclamation Division for annual fees due <br />// Annual Report <br />v/ Map <br />Remarks: <br />Signature <br />