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eke 13Z25 � ��gs -°= <br /> 999 <br /> ANNUAL FEE and REPORT REOUEST PECEBVi�D <br /> Nov <br /> ' 3 ?Q//G <br /> PERMITTEE NAME: Parkerson Construction, Inc. <br /> PERMIT NO.: M-1990-094 Division of Ilginerdls and Dgo109y <br /> OPERATION NAME: Orchard Grove Ind <br /> ANNIVERSARY DATE: November 9,2000 <br /> ANNUAL FEE DUE: $688.00(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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning 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 <br /> 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, Inc. <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 <br /> enclosed. <br /> x <br /> ignature of orporate Officer or Owner <br /> Date <br /> SIVERWrWASTERDOCUMENTSW AF-01 <br />