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<br /> <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Cooley Gravel Co <br />M-82-155- <br />CHRISTIAN PIT <br />02 / 22 / 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 <br />Land Reclamation Division for annual fees due <br />X Annual Report <br />X Map <br />Remarks: The annual fee of $350.00 has been paid and was submitted <br />under separate cover by check #0083. <br />Signature <br />