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• <br /> <br />• <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />CBW Builders Inc <br />M-80-080- <br />Una Pit <br />07 /24/86 <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 Land Reclamation <br />Division for annual fees due <br />~ Annual Report (S.e~ ~~~ R^^dL at.Y~.cD,a~ .~+~ti~ <br />V, Map <br />Remarks: <br />