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ANN FEE and REPORT REQUEST <br />~~~~-~1,/~® <br />PERMITTEE NAME: ~Parkerson Brothers LLC <br />PERMIT NO.: ~M-1984-001 ~ ~ ~R t~ 6 ~'~07 <br />Reclamatio <br />OPERATION NAME: Surface Rock I'it ~'nin9 and Safety n' <br />ANNIVERSARY DATE: Apri14, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished_to_date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be p~:rformed during the coming year, the dates for t}re beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report .and annual report map to this form. The Amrual Report <br />& Fee requirement is not met until we have received the following components: See, report, aml associated <br />map. If no new disturbances or reclamation have occurred durinc the previous veer and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make arty necessary <br />changes: <br />Permittee Contact: Alan Parkerson <br />Permittee Name: Parkerson Brothers LLC <br />Address: 710 S 15th St. <br />Grand Junction, CO 81501 <br />Phone Number: (970) 242-8134 <br />Fax Number: at`10-a.~ia-89~`I <br />If you have additional comments and/or information that should be provided to the Division, plea:~e provide it <br />below or attach it to this form along with your written. report and map. Annual Report instructions are enclosed. <br />Signature of Corporate fficer, Owner, or Designee <br />+-1- <br />Date <br />