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::, <br />r/ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Evan L. Melby, Inc. <br />M-1999-073 <br />Pit I <br />February 7, 2003 <br />RECEIVED <br />FEB 0 7 2003 <br />Division ~f Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Costilla <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 xhe-annual-fee,-a-report and-map showing-the extent ~of current-disturbances to affected lahd; --- - -- <br />reclamation accomplished to date and during 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 ym~r revised written anneal rennet and annual re~prt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: <br />Permittee Name: <br />Address: <br />Evan Melby <br />Evan L. Melby, Inc. <br />P.O. $ox 4159 <br />Ventura, CA 93007 <br />Phone Number: (800) 858-8565 <br />Fax Number: (805) 647-8832 <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. Annua] Report instructions are enclosed. <br />Signature of Cor]]polIrate Officer, Owner, or esignee <br />Date <br />M:IPERMITU9ASTERD000MEMSIM-AF-01 <br />