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<br />~, i ~~ I E of cuLUl,nuu <br />DIV[S10N OF MINEU LAIIU RECLAi•1AilON <br />COAL PROGRAi4 <br />Civil Penalty Worksheet <br />I. Identification <br />Permfttee/Operator /n'jlrliP('~1,nc <br />Date of Issuance y /~/Y) <br />Type of Violation <br />Administrative <br />Performance Std. __~~_____ <br />Permit Condition <br />II. Action <br />Penalty Assessed iI~_Yes No <br />Proposed Amount `b 7% <br />Source of information or assessment <br />Operator/Permfttee <br />Division ~ <br />III. Mandatory Penalties <br />Cessation Order <br />Failure to Abate $750.00 - $5,000.00/day X days <br />Mining Without a Permit <br />IV. Penalty Calculation Criteria - Rule 5.04.6 <br />Cateaorv Comments _ <br />A. Wi tory <br />NOV's past 12 months x $50.00 <br />CO's past 11 months x $250.00 <br />B. Seriousness <br />Severe <br />Significant <br />Low/Moderate <br />Insignificant <br />Aclministrative <br />C. Fault <br />Intentional <br />Negligence <br />Unavoidable <br />;1,500 E1,150 <br />$1,000 $1,250 <br />$250 ~50~ <br />$~ <br /> <br />5750 <br />$1,500 <br />$750 <br />I~GeRagP ~:i'rl YIP 3~l~nn~~r~l~ -("ri,3 /LEA/ <br />r i it n+! l(tJ Ili nr'rr:e l e tcYcu f ; <br />~-u~ ~(,~~z(,r1lr Irsr.bl~, r ~,F ri~ fair <br />/ 1 ~ ( r~,!/!(lr ~f C7 F,r, 1 Fl.l Ill / '~n ,' Il„/ F' <br />S'rrin,ls tl7~tnin9~ /~ t~<'(u!. `~ `J ~~? <br />$1,000 $1,250 <br />~~~ $500 <br />$0 <br />D. Number of Days Penalty Assessed ,~_ <br />E. Good Faith (may not exceed $1,250.00) <br />Credit - Extraordinary Effort <br />Credit - Rapid Compliance <br />TIFF ,n31,; ~;/G y ;,F -li,r- fy,; (r(~ ~tY(s lr l~(~ <br />lnc~E~u((3 (n ~/iP /C,iy/ 6y //~- ~jc'ryrrl'.~% <br />r f (n~rP ~(rQ,n~fP s rru~ ~vlPJ /~~.~ 6Pwr <br />Inir~l(ecl, .~~5~ <br />/~~/L <br />75 ~~ <br />l~ ,~ l~~zcG~l ~ Assessment Officer <br />4lgnatur p ,_,l <br />Gd~rr; l , ~~u !I Pq Date~~,rj/ ~~~ <br />Name PrYnted <br />4672E <br />