2007-02-07_REPORT - M1999073 - Laserfiche WebLink

Home Browse Search

~~ - ~~~,~,~1~~ ANNUAL FEE and REPORT REQUEST " ~tvi3t~~B ~ 120pJ PERMITTEE NAME: t~/Evan L. Melby, Inc. ~~n~~9a de of f~ oq PERMIT NO.: v M-1999-073 OPERATION NAME: Pit 1 ANNIVERSARY DATE: February 7, 2007 ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) COUNTY: Costilla 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 and map showing the extent of current disturbances to affected land, -- reclamation accoinplished~o-date and during the preceding year, n'ew disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written annual reuort and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map. If no new disturbances or reclamation have occurred durinc the urevious veer and no new chances to the previous year's man are necessary, then no new mao is required, urovided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may since for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Permittee Name: Address: Evan Melby Evan L. Me1by,Inc. P.O. Box 4159 Ventura, CA 93007 Phone Number: (800) 858-8565 Fax Number: (805) 647-8832 If you have additional comments and/or information that should be provided to the Division, please provide it tfeTbev~or attach it to this form along with your written report and map. Annual Report instructions are enclosed. Signature of Corporate Officer or Date