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RECEIVED <br />AUG 02 2.012 <br />Division of Declamation, <br />Mining and Safety <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 />f <br />UNITED STki ( <br />\-Yuok-Al- S, 0.mzw4 avd <br />SENDER: COMPLETE THIS SECTION <br />Rushton Backer <br />C.B. Company, LLC <br />8717 Delgany Ave. <br />Apt. 215 <br />Playa del Rey, CA 90293 <br />PS Form 3811, February 2004 <br />A. t .0 •..�'2 -;sit <br />e aid <br />,,• -4 "'"°'"°b , ''""""""'. "`- "'_...r <br />r ` <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 />Spec.S6 L <br />File . t cAS <br />CV- aol -oo5 <br />ii „i,ii,,,,,i, Iii,,,,, ii , „ i , i „ i , i , i „ ► „ ii „ „i,i,i <br />COMPLETE THIS SECTION ON DELIVERY <br />2. Article Number 7009 2820 0003 5701 3937 <br />(Transfer from service label) — <br />3. Service Type <br />0 Certified Mail <br />0 Registered <br />0 Insured Mali <br />Domestic Retum Receipt <br />A. Signature ' J <br />x ,C, ( . <br />❑ Agent <br />0 Addressee <br />B. - rived by ( Prnt e Name) C. Date of Delivery <br />D. Is delivery address different from item 1? 0 Yes <br />If YES, enter delivery address below: 0 No <br />0 Express Mail <br />0 Return Receipt for Merchandise <br />0 C.O.D. <br />4. Restricted Delivery? (Extra Fee) 0 Yes <br />102595 -02-M- 1540 <br />