2006-03-30_REPORT - M1999073

• Permit No: M1999073
• IBM Index Class Name: Report
• Doc Date: 3/30/2006
• Doc Name: Annual Fee/Report/Map
• From: Evan L. Melby Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

03i 30/2006 17:35 FAX
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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE;
ANNUAL FEE DUE:
COUNTY:
Evan L. bfelby, Inc,
/M-1999-073
Pit I
February 7,2006
$281.00 (Due on or before your amiversary date)
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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 shall submit the annual fee, a report end map showing the extent of current disturbances to affected
land, reclamation accomplished to date anJ during the preceding year, new disturbances that are anticipated to
.occur dwing the upcoming year, reclamafion that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased fur the year, if any.
Please attach your revised written annual report and aanual report map to this farm. Please pale iha! an
adeyrru[ely labeled map that clearly delineates and includer [he alcove elements may since for a written report.
Division records indicate the following pennittee contact information. Please verify and make any necessary
changes;
Permittee Contact; Evan Melby
Petmittee Nattte: Evan L. Melby, Inc.
Address: P.O. Box 4159
Ventura, CA 97007
Phone Numher: [phone]
Fax Number: [phone]
It' you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
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