2001-11-09_REPORT - M1990094

• Permit No: M1990094
• IBM Index Class Name: Report
• Doc Date: 11/9/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST

PERMITTEE NAME:
PERIv1IT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Parkerson Construction,lnc.
M-1990-094
Orchard Grove Ind
November 9, 2001
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flivision of Minerals and Geology
$685.00 {Due on or before your anniversary date)
Mesa
According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on [he anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing [he extent of current disturbances to affected land,
reclamation accomplished-to date and during [he preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. Please mote drat at:
adequately labeled map tlrat clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Permittee Contact: Alan Parkerson
Permittee Name: Parkerson Construction, Inc.
Address: 710 S. 15th St.
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of C rporate Officer or Owner
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Date
M' W ERM I"IN7 ASTERD(K U M ENTSUI ~ AF-01