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UNITED STATEWWW �l <br />First -Class Mail <br />Postage & Fees Paid <br />USPS <br />Permit No. G-10 <br />• Sender: Please print your name, ad, tNl�nd ZIP+4® in this box* <br />STATE OF COLORADO on o{ Red jeti1 <br />DEPARTMENT OF NAT h8RCES <br />DIVISION OF RECLAMATION, MINING & SAFETY <br />1313 SHERMAN STREET, SUITE 21.5 <br />DENVER, CO 80203-2243 — - <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 />Trent Peterson ; <br />GCC Energy, LLC <br />6473 Co. Ra. 120 <br />Hesperus, CO 81326-9633 <br />C-1981-035 <br />CV -2015-001 <br />mit/ahh <br />Notice and Order to pay <br />)fit <br />A. Signature � <br />X 0 Agent <br />❑ Addressee <br />B. Received by (Printed Name) C. Da of Divery <br />7,15D. Is delivery address different from item 1? ❑ Ye <br />-w4 -Y96, enter delivery address below: ❑ No <br />3. Service Type <br />❑ Certified Mail® ❑ Priority Mail Express - <br />E3 Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number LL 7010 1060 0001 0936 0888 <br />(transfer from service,_ <br />PS Form 3811, July 2013 Domestic Return Receipt <br />