Laserfiche WebLink
UNITED STS -c?f£: ;,: ws: 4firstss <br />R <br />AUG 0 2 2012 <br />rDEPARTMENT Please print your name, address, and ZIP +4 in this box <br />Division of Reclamation, <br />• <br />Mining and Safety <br />OF COLORADO <br />OF NATURAL RESOURCES <br />ON OF RECLAMATION, MINING & SAFETY <br />HERMAN STREET, SUITE 215 <br />R, CO 80203 <br />Spec.5AL <br />File <br />COMPLETE THIS cv- aoia -oo5 <br />SECTI ON D ELIVERY <br />C OMPLETE • <br />A. sig ture <br />item 4 if Restricted DeAvery is desired. X e',�� �- [3 Addressee <br />• Print your name and address on the reverse C. Date of Delivery <br />so that we can return the card to you. B. Ived by (Print2d - 'Name) <br />• Attach this card to the back of the mailpiece, v 7 <br />or on the front if space permits. D. Is delivery address different from item 1? 1 : 1 Yes <br />1. Article Addressed to: If YES, enter delivery address below: ❑ No <br />Rushton Backer <br />C.B. Company, LLC <br />8717 Delgany Ave. 3. service Type <br />Apt. 215 [3 Certified Mall ❑ Express Mail <br />Playa del Rey, CA 90293 [3 Registered 13 Return Receipt for Merchandise <br />❑ Insured r-3 Mait C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7009 2820 2003 5721 3937 <br />(transfer from service label) _ - _ _ _ - -- - - <br />PS Form 3811, February 2004 <br />Domestic Return Receipt 102595-02-M-1540 ; <br />