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2014-06-12_REVISION - C1980007 (4)
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2014-06-12_REVISION - C1980007 (4)
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Entry Properties
Last modified
8/24/2016 5:44:45 PM
Creation date
6/16/2014 7:55:15 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980007
IBM Index Class Name
Revision
Doc Date
6/12/2014
Doc Name
Certified Return Receipt (Inspection Notification)
From
OSM
To
DRMS
Type & Sequence
SL6
Email Name
JRS
DIH
Media Type
D
Archive
No
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UNITED STATES POSTAL SERVICE First -Class Mail <br />Postage & Fees Paid <br />LISPS <br />Permit No. G -10 <br />• Sender: Please print your name, address, and ZLR*iWiiis box • <br />v <br />State of Colorado Zti0' & <br />Department of Natural Resources 01 <br />0 <br />Division of Reclamation, Mining & Safety 6' Po w*', <br />1313 Sherman Street, Suite 215 0\\. <br />CO 80203 <br />C- 1980 -007 <br />SL-6 <br />Inspection Notification <br />i ii 4 )i jrslahh <br />• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />A. Signature <br />� <br />X <br />❑ Agent, <br />❑ Address <br />B. Received by (Printed Name) C. Date of E <br />�E- L✓ A- 40-c- h a C7 0 wo -�' <br />D. Is delivery address different from item 19 ❑ Yes <br />AIan JBoehms If YES, enter delivery address below: 0 N <br />Office of Surface Mining <br />Western Regional Coordinating Center <br />1999 Broadway, Suite 3320 <br />Denver, CO 80202 <br />J <br />Service Type <br />❑ Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7009 2820 0003 5700 5970 <br />(transfer from service labell <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />
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