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i <br />Permittee Name: Holyoke Gun Club <br />Operation Name: HOLYOKE GUN CLUB PIT <br />Permit No: 77-75 <br />Anniversary Date: September 27 <br /> <br />110 and Ill Attachment <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I_I Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I_I Annual Report , <br />Remarks: <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1782 <br />