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:~ <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C_003_g0 <br />C.O. N0. <br />N.O.V. N0. C-&4-064 <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 July~$zZ, , <br />19 85 <br />Signature of Person erved <br />if personal service <br />nt Name and Title <br />Certified Mail No. P 652 676 097 <br />Return Receipt quested <br />. ~ ~ ~ <br />ignature <br />~~ichaei S. Savage - Assessment Ofificer <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 />Operator <br />(5/85) <br />By <br />Signature <br />Date 19 <br />Doc. No. 251 <br />