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J <br />~; <br /> <br />• <br />MINED LAND RECLAMATION DIVISION <br />_ CERTIFICATE OF SERVICE <br />PERMIT N0. C-34-062 <br />C.O. N0. N/A <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 by epositing a true <br />copy thereo first c ass postage prepaid in the Unite States mails at Denver, <br />Colorado, addressed to the operator at the address above, on June 24 , <br />19 85 . <br />igna ure 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 />afl~. r „v <br />$i a ure ~ <br />~1ichael S. Savage Assessment Officer <br />Print Name and it e <br />* ---- Check applicable method of service. <br />REQUEST FOR CONFERENCE <br />Operator <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 />Ooc. No. 251 <br />By <br />Signature <br />Date 19 <br /> <br />