2017-02-14_REPORT - M1985219

• Permit No: M1985219
• IBM Index Class Name: REPORT
• Doc Date: 2/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Parkerson Construction
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Alan Parkerson
Permittee Company: Parkerson Construction, Inc.
Address: 710 S. 15th St
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Alan Parkerson
Company: Parkerson Construction, Inc.
Address: 710 S. 15th St
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Alan Parkerson
Company: Parkerson Construction, Inc.
Address: 710 S. 15th St
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance wit t Division approved mining and reclamation plans.
Signature o Permittee,C rnorate Officer,Owner,or Documented Designee Date
M-AF-01