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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t';? * W'?_ <br />ANNUAL FEE and REPORT REQUEST <br />Parkerson Brothers LLC <br />M-1984-001 ?? <br />Surface Rock Pit <br />CE <br />V'MAY 112009 <br />Division of Rec?amation; <br />Ub tg and Safety <br />April 4, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Mesa <br />According to 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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />---reclamation-accomplished to-date-and-dur-ing-the preceding-year-,--new-disturbances that-are-anticipated-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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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 Brothers LLC <br />Address: 710 S. 15th St <br />Grand Junction, CO 81501 <br />Phone Number: (970) 242-8134 <br />Fax Number: <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 />I L <br />Signature of Corporate Officer, Owner, or Designee <br />J4?