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' COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> 1313 Sherman Street,Room 215 <br /> Denver,CO 80203-2243 <br /> 341300000 <br /> Thomas O'Rourke <br /> O'Rourke Excavating, Inc. <br /> 2489 CR 18 <br /> South Fork, CO 81154 <br /> COMPLETE • <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. ❑Agent <br /> X <br /> ■ Print your name and address on the reverse ❑Addressee <br /> so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. <br /> 1. Article Addressed to: <br /> D. Is delivery address different from item 1? ❑Yes <br /> If YES,enter delivery address below: ❑No <br /> Thomas O'Rourke <br /> O'Rourke Excavating, Inc. <br /> 2489 CR 18 <br /> South Fork, CO 81154 3. Service Type <br /> ❑Certified MaiP- ❑Priority Mail Express" <br /> M-2014-005 ❑Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mail ❑Collect on Delivery <br /> 4. Restricted Delivery?(Extra Fee) C]Yes <br /> 2. Article Number <br /> (Transfer from service label) 7 014 2120 0001 7885 4565 <br /> PS Form 3811,July 2013 Domestic Return Receipt _ <br /> Postal <br /> CERTIFIED © RECEIPT <br /> _n Ln <br /> Domestic Mail Only <br /> u1 Ln <br /> CD co <br /> cc co Postage $ <br /> r9 r9 Celled Fee <br /> E3 Return Receipt Fee Postmark <br /> C3 C3 (Endorsement Required) Here <br /> E3 C3 <br /> Restricted Delivery Fee <br /> C3 O (Endorsement Required) <br /> ru ru <br /> r-q N Total Postage 8 Fees <br /> ru-- Thomas O'Rourke <br /> Sent To O'Rourke Excavating, Inc. <br /> C3 C3tieei&4pf.No:, 2489 CR 18 <br /> N r- or PO Box No. --- South Fork, CO 81154 <br /> Clq;State,ZIP+4-"- <br /> M-2014-005 <br /> :rr r <br />