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• • III IIIIIIIIIIIIIIII <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-84-065 <br />C.O. N0. <br />N.O.V. N0. G-88-027 <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 * by depositing a true <br />copy thereo first c ass postage prepaid in tthe Un~ States mails at Denver, <br />Colorado, addressed to the operator at the address above, on ,1„nP ~~ , <br />19 88. <br />ignature o erson erve <br />if personal service <br />Print Name and it e <br />Certified Mail No. P'765 476 173 <br />Return Receipt,R queste <br />~" <br />igna ure <br />Ass ssment Officer <br />print Name and it e <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 />Operator <br />(5/85) <br />By ~ ~/~~ ~y ~~ ~~~ <br />~ Signature <br />Date ~-: ~%- ~ 19(14 <br />;~ <br />v <br />Doc. No. 251 <br />