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.. • III IIIIIIIII IIII III • <br />-. ~]l0and~1ll--Enc]~osure <br />. _ , <br />Holyoke Gun Club <br />Permittee Name: .. <br />Permit No: M-77-075 SEP~~ d 1986 <br />Operation Name: Holyoke Gun Club Pit <br />09/27/86 ~' ~ ~ '•, ; r •. r : ~,. R <br />Anniversary Date: ..:: ,...'~ ;.,, , • , <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 <br />Remarks: ~,,,. ~~ .r-,_~ fC~A'A ~ ~x ~2trf ,~..~.es .V~ <br />/`T// ,1 ` ~// <br />/jai, / V /il/L/ iC~l/~Y ~~ i/ N~Z~ i( ~l/L.C.~~-~C <br />"~ <br />• ~ <br />Signature <br /> <br />roll(~6 <br />~~~~~ <br />~; ~ <br />