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~~ <br /> <br />110 and 111 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Mowbray Gravel <br />M-79-166 <br />Mowbray Gravel Pit <br />09/04/86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />~~0.00 Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: There has been no gravel mined in the last year. <br />It is the same as last year <br />r <br />~ '' 1 i'" ~ <br />Signature <br />k~(ia.( ~ <br />~r-~.~~ <br />F-, (~ <br />