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<br /> <br />Permittee Name: Andesite Rock Co <br />Permit No: M-77-141 <br />Operation Name: Lyons Quarry <br />Anniversary Date: 12 / 29 / 86 <br />.. <br />~t DEC 23 1956 <br />MINED LAND <br />-1tC~AMATION DIVISION <br />/112 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />i Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br /> <br />Signature <br />~J <br />1 ~/a~/b'6 <br />~ s~ V <br />_~ <br />