2006-02-09_REPORT - M1999073

• Permit No: M1999073
• IBM Index Class Name: Report
• Doc Date: 2/9/2006
• 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

V ANNiiAi. FF.F. and RF.P(lRT RF.tNiF.4T
RECEIi/ED
PERMTTTEE NAME: / Evan L. Melby, Inc.
PERMIT NO.: t/ M-1999-073 ~ FEB 0 ~ pppg
OPERATION NAME: Pit 1 '/Drvrsrort or rv„nz~als and GeMogy
ANNNERSARY DATE: February 7, 2006
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 feed a-report-and-map-showing the -extei~of current- disturbances to affected' land,-
reclamation accomplished to date and during the preceding year, new 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 fir revised written anneal report and anneal repnrf man to thic form. 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:
Evan Melby
Evan L. Me1by,Inc.
Address:
Phone Number:
Fax Number:
P.O. Box 4159
Ventura, CA 93007
[phone]
[phone]
If 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.
Signature of Corporate Officer, Own , or Desi e
1~2~a~0~~
Date