Laserfiche WebLink
JCS <br />ti <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-81-013 <br />C.0. N0. C-88-017 <br />N.O.V. N0. <br />I hereby certify that I served a copy of the foregoing NOTICE OF PROPOSED AMOUNT <br />OF CIVIL PENALTY on the operator therein described by _(a)* personal service <br />upon the operator or its representative at , <br />Colorado on 19 or ~ b * by depositing a true <br />copy thereof first c ass postage prepaid in the United States mails at Denver, <br />Colorado, addressed to the operator at the address above, on Aoril 21 , <br />19~. <br />ignature o erson erve <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 168 479 913 <br />Return Re~~cj~eipt Re bested <br />~~$ignatuy <br />Michael 5. Savage Assessment Officer <br />Print Name and Title <br />* ---- Check applicable method of service. <br />REQUEST FOR CONFERENCE <br />The operator above described hereby requests an assessment or settlement <br />conference as permitted by C.R.S. 34-33-123(8). <br />~~~~~~~~ <br />i,1gY ~~ 1988 <br />MINED LAND <br />[7ECLAiVIA?IOf~ IUIVISION <br />(5/85) <br />Doc. No. 251 <br />i~- <br />Op rator <br />By <br />Signature <br />Date Ma Z 19~~ <br />.= <br />