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• ~. <br />stn1E or cuLOUnuo <br />DIVISIOtI OF MINEU LANU RECLnMnifON <br />COnL PROGRnt4 <br />Civil Penalty Worksheet <br />I. Identification <br />Permt ttee/Operator hAOttit Edn1(Od ~ CO . <br />Permi t No. ~ - k ~-00~ <br />NOV/CO No. C-`i -avh <br />Date of Issuance d-19-`!~ <br />Type of Violation <br />Administrative )C <br />Performance Std. <br />Permit Condition ~_ <br />II. Action <br />Penalty Assessed Yes No <br />Proposed Amount ~'S`c~4 °~ <br />Source of information or assessment <br />Operator/Permittee <br />Division <br />III. Mandatory Penalties <br />Cessation Order <br />Failure to Ahate $750.00 - $5,000.00/day X ~ days <br />Mining Without a Permit <br />IV. Penalty Calculation Criteria - <br />Cateaorv Rule 5.04.6 <br />Comments <br />A. History s-~c~ /~~/~Cff-E~ Coa-N[~a7r' <br />~ NOV's past 12 months x $50.00 ~~ <br />CO's past 12 months x $250.00 <br />B. Seriousness <br />Severe ;1,500 $1,150 <br />Significant $1,000 $1,250 <br />Low/Moderate ;250 $500 $750 <br />Insignificant $0 . <br />• Administrative $ 2 ~~ <br /> ~'1 SU <br />C. Fault <br />Intentional $1,000 E1,250 $1,500 <br />~'z s D <br />Negligence $250 $500 $750 <br />Unavoidable $0 <br />0. Number of Days Penalty Assessed <br />E. Good Faith (may not exceed $1,250.00) ~ ~ <br />Credit - Extraordinary Effort <br />Credit - Rapid Compliance o a <br />S o~• <br />~~pp ,~/ TOTAL <br />n~7 r~.~// Assessment Officer <br />Signatur <br />_f G~rv ~' l~oa~PH Date 3'l~-~t~ <br />Name Pflnted <br />4672E <br />