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III IIIIIIIIIIIII III <br />999 <br />STATE OF COLORADO <br />DIVISION Of MINERALS AND GEOLOGY <br />COAL PROGRAM <br />l;tY11 Penalty Worksheet <br />Identification <br />[I. Action <br />Pennittee/Operator ~~~'bYG'.cc~~o{tldtfY Penalty Assessed Yes No <br />Permit No. ~-k 3-(759-- Proposed Amount <br />NOV/CO No. /'_ q3-D ~~ Source of information or assessment <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />C <br />PERMIT NO.:C-81-059 <br />.O. NO.: <br />N.O.V. NO.:C-93-071 <br />I hereby certify that I served a copy of the foregoing NOTICE OF <br />PROPOSED AMOUNT OF CIVIL PENALTY on the operator therein described <br />by depositing a true copy thereof first class postage prepaid in <br />the United States mails at Denver, Colorado, addressed to the <br />operator at the address above, on May 17, 1993. <br />Certified Mail No.: P 179 166 478 <br />Return Receipt Requested <br />Signature of Person Served (Signature) <br />(If personal service) <br />Larrv P. Routten, Assessment Officer <br />_ Print Name and Title Print Name and Title <br />ti ~ P 179 166 478 <br />p Reci;or CET REQUEST FOR CONFERENCE <br />~ ~ Cern I `11~AaR'~= - -- ----- <br />~ No InsL~l~e~o PrQI~ <br />Do not use for I na Iona SENDE <br />p (See Reverse) C I ~"' f I also wish t i~ h <br />~ <br />o Sam to <br />Terror r <br />~o, <br /> Sneer an No L' <br />7 O MW <br /> v D ~e antl ZIP Coae <br />V ~D ,2 <br /> <br />C Povage <br /> Cerplled Fee <br /> <br />~~ SPeual Dei~•erv Fee <br />O) Pesmaep Delme~y Fee <br /> <br />~ <br />m Return Recelol Sr¢wing <br />MW ~o Wf,um 8 Dade Dulrveietl <br />Tr <br />Mm Pelmn Recel Wnom, <br />r C <br />r ~ <br />' <br />- Ddle, and f S <br />1 <br />[ <br />+ <br />~~ ioTPL <br />6 Ree nl C~ O <br /> Pos ark r~ ` • ,~ <br />Z <br />7` <br /> ` <br />C <br /> / <br />~Z ~ <br />o .~~ ` ' <br />m \\f ~:, <br />~ <br />a ___ <br />Omp. ate iterrAa h..e~M or ] iar etltllbonel eervicea. <br />• Complete itemio.'and 4a 6 b. O face ve t B <br />}O~IOWInQ aerViCBS (for 0n a%trB <br />• Print,your name,~t~ eddreae on the reverse of Chia form so That we can <br />• feel: <br />rsturn.thiaperd to Ski: ' <br /> <br />• Atwch this form'i6~theJront of the meilpieca, or on the bck it apace _ <br />J. ^ AddresSBe's~Addrees <br />dosa nl;t permit. ^" <br />• Write"fllfiurn Receipt f)eq~etetl"on the merlpiece bebw[he Miele number. 2 ^RBStflCted DeliVBry <br />• The Retum Receipt Fae will provide you the eianature of the person dslivere <br />to'and the tlete of delivery. Consult Ostmaster fOr fee. <br />3. Article Addressed to: 4a. Article Number <br />~f~rof C~~ ~O, <br />l~ ya y;wey l3~ <br />PQOntq~ ~'O ~/`l2~ <br />5. <br />70 <br />Registered ^ Insured <br />Certified ^ COD <br />Express Mail ^ Return Receipt for <br />Merchandise <br />Date of Delivery <br />-ai- <br />and fea is paid) <br />