2005-01-24_REPORT - M1987178

• Permit No: M1987178
• IBM Index Class Name: Report
• Doc Date: 1/24/2005
• Doc Name: Annual Fee/Report/Map
• From: Parkerson Construction Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Parkerson Construction, Inc.
M-1987-178
31 Road Pit
February 12, 2005
$688.00 (Due on or before your anniversary date)
Mesa
JAN 2 4 2GC5
9iuision of Minerals t'r G~1nIeCi
' "7lccor~lc mg"t~:R:S`3~I=3Z:5-11 or :5-34=32=116,-e'ach-yeai=; on the anniversary"date of the permit; an operafoF-- I
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation-awomplished-to date and-during the-preceding-year; new-disturbances-that are anticipated.to_occur_ I
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 ynnr reviced written anneal report and anm~al re~nrt main to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements naay suffice for a written report.
Division records indicate the following permittee 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 Corporate Officer, Owner, or Designee
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