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• ~ • <br />Permit No: 77-81 GREELEY WEST PIT <br />Anniversary Date: September 12 <br />Operator: <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 I•tined Land <br />/- Reclamation Division for annual fees due <br />Annual Report <br />Map <br />Remarks <br />