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DIVISION OF MINERALS AND GEOLOGY <br />CERTIFICATE OF SERVICE <br />Permit No. C-80-005 <br />NOV No. C-95-014 <br />I hereby certify that I served a copy of the foregoing NOTICE OF PROPOSED AMOUNT OF CIVIL <br />PENALTY on the operator therein described by depositing a true copy thereof, first class postage <br />prepaid, in the United States mails at Denver, Colorado, addressed to the operator at the address above, <br />on June 6, 1995. <br />Certified Mail i~g. P 296 607 530 <br />Return R equested <br />Signature of Person Served Signatwe <br />if Personal Service <br />David A. Bern. Assessment Officer <br />Name and Title (Print.Name and Title) <br />REQUEST FOR CONFERENCE <br />The operator above described hereby requests an assessment or settlement conference as permitted by <br />C.R.S. 34-33-123(8). <br />Operator <br />By <br />Date <br />(Signature) <br />1995 <br />~s~vMROrr+~,rr <br />