2017-11-03_REPORT - M1990094

• Permit No: M1990094
• IBM Index Class Name: Report
• Doc Date: 11/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Parkerson Construction, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• Media Type: D
• Archive: No

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Mvision records indicate the following perrmitteellandowner contact information (blank fields indicate #hat we do not Ira:: ti
inforimation.oa record). If this information is blank or not current, please type orpint t contact informal
I-Vermritee Pw13T-x.--
M'Permrttne�v:
Yaficzcson
Address~
710 S. 15th St
Grand Junction, CO 81501
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
Permitting Contact:
Alan Parkerson
Company:
Parkerson Construction, Inc.
Address:
Phone Number:
710 S. 15th St
Grand Junction, CO 81501
[phone]
Fax Number:
Email Address:
Inspection Contact:
Alan Parkerson
Company:
Parkerson Construction, Inc.
Address:
710 S. 15th St
Grand Junction, CO 81501
Phone Number:
[phone]
Fax Number:
Email Address:
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 with the Division approved mining and reclamation plans.
Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M AFA I