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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1999073 <br /> Evan L. Melby, Inc. Receipt#: 23049 <br /> Evan Melby Date: 03/06/2017 <br /> P.O. Box 4159 <br /> Permit: M1999073 <br /> Ventura CA 930070000 <br /> MethodPayment Revenue Code Fee D• Other <br /> Check#15324 4300-MAFO Minerals Annual Fees $323.00 <br /> Due 02/07/17-Fee Only <br /> Receipt Total: $323,00 <br /> RE,DE,IVED <br /> MAR O a Z017 <br /> OF NECLAMATION, <br /> 0I1A SAFETY-MINERALS <br /> FEE eMPOR7 MAP <br /> Page 1 of 1 <br />