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_1. G,2S <br />~ ~ <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-R1-010 <br />C.O. N0. <br />N.O.V. N0. C_a~_naa <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 ~ 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 .~a,,,,arv_Fi _ , <br />19 88. <br />Certified Mail No. P 051 874 864 <br />Return Receipt Req ested <br />~~, f--- <br />ignature o erson erve ignature <br />if personal service <br />Michael S. Savage, Assessment Officer <br />Print Name and Title 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 /> <br />Operator <br />gy ~ . ~ . ~. <br />Signa <br />Date ~ ~ OJT 19 ~~ <br />(5/85) <br />Doc. No. 251 <br />