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<br />Pennit No: 81-2 MDUNTAINVIEW PIT <br />Anniversary Date: July 15 <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 Colorado i+lined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />~~w <br />Sign~ure <br />