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<br />-, <br />0 <br />MINED LAND RECLAMATION DIVISION <br />- CERTIFICATE .OF SERVICE <br />PERMIT N0. C-84-062 <br />c.o. No. N/A <br />N.O.V. N0.- <br />• <br />.. ~~1/ <br />. - . <br />' U; . <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 XX * by epositing a true <br />copy thereo first c ass postage prepaid in the Unit 3 States mails at Denver, <br />Colorado, addressed to the operator at the address above, on June 24 , <br />19 85 . <br />ignature o erson erve <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 652 676 053 <br />Return Receipt Requested <br />,ifl ~-:• <br />° i ature <br />rlichael S. Savage Assessment Officer <br />Print Name and itle <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 />(5/85) <br />O 1(~ f :L c~ p ~ ~ d <br />Operator <br />BY / „~~ <br />i na ur <br />Date / ~ ~ 19 a'S <br />Doc. No. 251 <br />