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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Parkerson Construction Co. <br />M-1987-178 <br />31 Road Pit <br />February 12,2002 <br />RECEIVED <br />FE819.1002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Mesa <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-] 16, 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-daring-the preceding year, ae•.v disturbances [hat are-an[icipated-to-oeeur---- <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 [he year, if any. <br />Please attach Vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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 Co. <br />Address: 710 S.' 15th St. <br />Phone Number: <br />Fax Number: <br />Grand Junction, CO 81501 <br />(970)242-8134 <br />L970) 242-8977 -- ---- -- ~- -- - - -- -- -- --- ---- ----- - --- <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 />ignature of orporate Officer or Owner <br />2 /5~-0 <br />Date <br />hi:7PERM ITU~IASTERDOCOMENTSVN-AF-01 <br />