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~~~ I~~II~~I~II~~I~~' <br />ANNUAL FEE and REPORT REQUEST <br />NOU 2 3 ~n~1 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Parkerson Construction Co. <br />M-1978-323 <br />Woodring Pit <br />November 22, 2001 <br />RECEIVED <br />~'o <br />Division of Miner;.:.; a ~d Geology <br />$688.00 (Due on or before your anniversary date) <br />Mesa <br />According [o 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 />shalll'stibinit the annaal-fee, a report~andZnap showing-the extent-of-current disturbances to affected land, <br />reclamation accomplished to-date and during the'precediug year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will beyerformed 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 your 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 permit[ee 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 />Grand Junction, CO 81501 <br />Phone Number: (970) 242-8134 <br />Fax Number: (970) 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 />Signature of rporate Officer or Owner <br />~"~/ <br />Date <br />M: WERMI'1'\MASTERDOCUMENTSUf-AF-01 <br />