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NZI <br />- . <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />Parkerson Construction Co. <br />N?? <br />M-1985-219 <br />32 Road Pit <br />March 14, 2011 <br />RECEAVF <br />MAR 00 2011 <br />Division u, r LC wiiatioo, <br />Mining and Safety <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- during the preceding year, new =disturbances that -are-anticipated--to occur - <br />--during-the upcoming year,-reclamation xhatwill be performed duringAhe-commg-_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 resort 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 may are necessary, then no new map is reguired, 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 Construction Co. <br />Address: 710 S. 15th St <br />Phone Number: <br />Fax Number: <br />Grand Junction, CO 81501 <br />(970) 242-8134 <br />(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 Corporate Officer, Owner, or Designee <br />Date