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fL?-- ,4- 2P T- <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Parkerson Construction Co. <br />PERMIT NO.: M-1978-323 ? ???? 0 2 2009 <br />OPERATION NAME: Woodring Pit Div"n of Recla ration, <br />Mintng and Safety <br />ANNIVERSARY DATE: November 22, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: 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-during =the-preceding-year, pat?zt-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 man 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 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 Park rson <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 long with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />1D121Z/1;, <br />Date