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■ Complete items 1, 2, and 3. Also complete <br />Kam 4 If Restricted Delivery Is desired. <br />a 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 mallplece, <br />or on the front If space permits. <br />1. Article Addressed to: <br />Mr. Jean De Ridder <br />Total E&P USA Oil Shale, LLC <br />705 Forest Ave. <br />Palo Alto, CA 94301 <br />A. Signature <br />x 0 Agent <br />C� Addressee <br />B. Received by (Printed Name) Date of Delivery <br />D. Is delivery address different from Item 17 O Yes <br />It YES, enter delivery address below. 0 No <br />8. Service Type <br />❑ Certified Mail* f3 Priority Mall Express - <br />f] Registered © Retum Receipt for Merchandise <br />_❑ Insured Mall 0 Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />2. Article Number 7 014 2120 0001 7869 8343 <br />(rmnsier from service label) <br />_ P5 Form 3811, July 2013 Domestic Retum Receipt <br />■ _ r ■ <br />�L <br />CS F <br />In - <br />if =10111�� 19 <br />� . 'n <br />COLORADO$•, <br />Division of Reclamation, rc <br />a s 5 <br />Mining and Safety ���s <br />a o <br />Department of Natural Resources $ V I E �' <br />1313 Sherman Street, Room 215 $ =P'z R <br />Denver, Co 80203-2243 � � m � �� g its � o . <br />CRT <br />341300000 <br />Mr. Jean De Ridder <br />Total E&P USA Oil Shale, LLC <br />705 Forest Ave. <br />Palo Alto, CA 94301 <br />