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<br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVILE <br />PERMIT N0. C-81-025 <br />C.O. N0. <br />N.O.V. N0. C-88-025 <br />CMT <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 ~~ Dy epositing a true <br />copy thereo first c ass postage prepaid in the United States mails at Denver, <br />Colorado, addressed to the operator at the address above, on Mav 31. <br />19 88 . <br />ignature o erson erve <br />if personal service <br />Print Name and it e <br />Certified Mail No. P 765 476 075 <br />Return Recei t R~u to <br />A <br />i ure <br />A essment Officer <br />Print Name and it e <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 <br />19 <br />Doc. No. 251 <br />