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PROOF OF STORMWATER PERMIT APPLICATION <br />Jack Clark, Jr. <br />Upper Animas Sand & Gravel <br />¦ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />¦ 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 mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />A. Signature <br />X ? Agent <br />.? Addressee <br />B. Recei (Printed Name) C. Date of Delivery <br />D. Is d a ifferent from stern 1? ? Yes <br />If YZter de ddress below: 13 No <br />Colo Dept of Public Health" <br />Water Quality Control Div <br />WQCD-Permits s fsuredgisteredMail ce <br />19 ert I ?Expressmail <br />4300 Cherry Creek Drive So t <br />eReturn Receipt for Merchandise <br />Denver, CO. 80246-1530 c.o.D. <br />4. icted Delivery? (Extra Fee) ? yes <br />2. Article Number <br />(Transfer from service /abed <br />7007 <br />Ps Form 3811, February 2004 Domestic Retu I I I I I I U I' I I I I I 11I I l i i') i i' I I I I„ I