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<br />t~dte of ServiCe__December 28_~ Iq _81 <br />person S?rvyd_ Mr. Craig Sherwood <br />Environmental Coordinator <br />(Pled"a? Dfint ndrte dntl title} <br />Sionat~re______ <br />(P?rson served) <br />N[MED L D °C I '?IV[ <br />aY- --------------- =- - --- -- <br />(dutnorized represe tativ?) <br />Robert G_ Liddle~ Reclamation Specialist _ <br />(`1 d:ro antl title - pladse print) <br />I~M?DRio:~i: PLEASE QEaD THE REvERSc' S[DE OF THIS pnGE. <br />LO/79 i..r2.S. 173, 34-33-IZ3 <br />