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• 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 />David Anderson <br />Western Fuels - Colorado, LLC <br />12050 N. Pecos St., Suite 100 <br />Westminster, CO 80234 <br />2. Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />UNITED STATES POSTAL SERVICE <br />• Sender: Please print your name, address, and ZIP +4 in this box • <br />STATE OF COLORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />DIVISION OF RECLAMATION, MINING & SAFETY <br />1313 SHERMAN STREET, SUITE 215 <br />DENVER, CO 80203 <br />C- 2010 -08 <br />CV- 2012 -0 <br />Notice of Proposed Amount of Civil Penalty, <br />„DIN/WILT/ANN <br />SENDER: COMPLETE THIS SECTION <br />COMPLETE THIS SECTION ON DELIVERY <br />A. lgnature <br />X <br />. Recelved by (Pm, <br />Agent <br />❑ Addressee <br />D. Is delivery address diffe 'from deoll? '0 Yes <br />If YES, enter delivery eddre'tis bgjd� %F�o <br />.1 of <br />3. Service Type <br />❑ Certified Mall <br />❑ Registered <br />❑ Insured Mall <br />4. Restricted Delivery? (Extra Fee) <br />7009 2820 0003 5700 6687 <br />C. Date of Delivery <br />12 - -1 I - IZ- <br />❑ ,,- <br />❑. Re Rg®{p£for1GIerchandise <br />❑ C.O.D. <br />❑ Yes <br />Domestic Return Receipt <br />RECEIVED <br />DEC 1 32012 <br />Division of Reclamation, <br />Mining & Safety <br />102595 -02 -M -1540 <br />First -Class Mail <br />Postage & Fees Paid <br />LISPS <br />Permit No. G -10 <br />