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MINED LAND RECLAMATION DIVISION <br />CERTIFICATE GF SERVICE <br />PERMIT NO.: C-81-041 <br />C.O. NO.: <br />N.O.V. NO.: C-91-021 <br />I hereby certify that ? served a copy of the foregoing NOTICE CF PROPOSED AMGUNT <br />OF CIVIL PENALT'!' on .he ooerator therein described by depositing a true copy <br />thereof first cuss postage prepaid in the United States mails at Denver, <br />Colorado, addressed to the ooerator at the address above, on October 25, 1991. <br />Certified +1ail No.: P 427 688 760 <br />Return Receipt Reque_5~ed <br /> <br />Signature of Person Served <br />if personal service <br />Print Name and Title <br />gnature <br />Print Name and Tit e <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 />Date <br />(Signature) <br />19 <br />DAB/scg <br />8968E <br />