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<br />ANNiiAi. FF.F, and RF.PnRT RFniiRST <br />PERMITTEE NAME: Parkerson Construction, Inc. NOV 1 p 2p(f3 <br />PERMIT NO.: M-1990-094 Division <br />nt Minerals and Cenlr. <br />OPERATION NAME: Orchard Grove Ind <br />ANNIVERSARY DATE: November 9, 2003 <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-I 16 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-extern-of-current--dirnvbances-to-affected-land; --_ <br />reclamation accomplished to date and during the preceding year, new disturbances that arere anucipatad to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal report and annual report man to this form. Please note that art <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Alan Parkerson <br />Permittee Name: Parkerson Construction, Inc. <br />Address: 710 S. 15th St. <br />Grand function, CO 81501 <br />Phone Number: (970) 242-8134 <br />---Fax Nueri (970}-2A2=8977 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Si na re of Corpoxa6 ffi r, Owner, or Designee <br />ii/~/o3 <br />Date ~- r <br /> <br />M:NERMI'M7ASTERD000M ENTSUI-AF-01 <br />