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- .~ •~ <br />Permit No: Al-4 <br />Anniversary Date: Fehruarv 7 <br /> <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 the Colorado Mined Land <br />~ Reclamation Division for annual fees due <br />gnature <br />Annual Report <br />y <br />