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<br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />N.O.V. N0. C-84-112 <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 X 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 Julv 3 <br />19 84. <br />Cert~ied Mail No. P 397 149 349 <br />Candace Thompson <br />Name Printed <br />(Signatur <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 />By <br />Signature <br />Date 19 <br /> <br />(1/83) <br />Doc. No. 251 <br />