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MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-050-80 <br />C.O. N0. <br />N.O.V. N0. C-85-081 <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 XX b * by depositing a true <br />copy thereof first c ass postage prepaid in the Uni e3 States mails at Oenver, <br />Colorado, addressed to the operator at the address above, on October 22 , <br />19 85 , <br />ignature o erson erve <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 652 676 294 <br />Return Receipt Requeste <br />~~a5 ~ <br />ignature ~- <br />Michael S. Savage Assessment Officer <br />Print Name and Tit 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 />By <br />e <br />(5/85) <br />Date <br />19 <br />Doc. No. 251 <br />