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SIAIL Of CULURADO <br /> _ -'ISION OF MINED LAND RECLAMATI <br /> COAL PROGRAM <br /> Civil Penalty Worksheet <br /> I. Identification II. Action <br /> Permi ttee/Operator Penalty Assessed h Yes No <br /> Permit No. Proposed Amount <br /> NOV/CO No. Zi Source of information or assessment <br /> Date of IssuanceT do U Operator/Permsttee <br /> Type of Violation Division _ <br /> Administrative <br /> Performance Std. k <br /> Permit Condition x <br /> III. Mandatory Penalties <br /> N( Cessation Order <br /> 0 Failure to Abate $750.00 - $5,000.00/day X days <br /> rv' Mining Without a Permit <br /> IV. Penalty Calculation Criteria - Rule 5.04.6 <br /> Category Comments <br /> A. History _-.--- -�_ <br /> S NOV' s past 12 months x $50.00 ( 41 ' <br /> o CO' s past 12 months x $250.00 <br /> B. Seriousness <br /> Severe $1 ,500 $1 ,750 <br /> Significant $1 ,000 $1 ,250 <br /> Low/Moderate $250 $500 $75.0-- <br /> Insignificant $0 <br /> Administrative $ <br /> C. Fault <br /> Intentional $1 ,000 $1 ,250 $1 ,500 <br /> Negligence $250 $500 ($750 , <br /> Unavoidable $0 <br /> D. Number of Days Penalty Assessed L <br /> E. Good Faith (may not exceed $1 ,250.00) <br /> Credit - Extraordinary Effort 1)o-1Q- <br /> Credit - Rapid Compliance <br /> -�_ TOTAL <br /> !' Assessment Officer <br /> S gnature '-- <br /> Date 'l A., <br /> Name Printed <br /> 4672F <br />