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.' <br />Permittee Name: CBW Builders Inc <br />Permit No: M-80-080- <br />Operation Name: UNA PIT <br />Anniversary Date: 07 / 24 / 85 <br />112 Enclosure <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 />Annual Report <br />Map <br />Remarks: <br />Signature <br />