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III IIIIIIIIIIIIIIII <br /> • <br /> IJU and. Ill Attachment <br /> Permittee Name: Union Carbide Corporation <br /> RECEIVEDOperation Name: <br /> Permit No: 77-299 1',IR I 1' <br /> Anniversary Date: March I L:ii.IU.NDRECIAMABONplri$ION <br /> CEIJ. G:pt. cf flatu,ul Re;pwis <br /> Please complete the following and return this form with your fees and <br /> reclamation data. <br /> Enclosed are: (Check box(es) ) <br /> —� Check or money order payable to Colorado Mined land <br /> Reclamation Division for annual fees due <br /> (—� Annual Report <br /> Remarks: <br /> Signature <br /> (Rev. 5/84) <br /> Doc. No. 1782 <br /> i <br />