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DIVISION OF MINERALS AND GEOLOGY <br />CERTIFICATE OF SERVICE <br />PERMIT NO.: C-$I- C'2C~ <br />C.O. NO.: n R <br />N.O.V. NO.: C-`)y"0~-? <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)'~ee <br />upon-the epera-tcr omits repre~Pnt~*~~e ~~ ~w <br />~- X OR (b)' by depositing a true copy thereof first class <br />postage prepaid in the United States mails at D nver, Colorado, addressed to the <br />operator at the address above, on /O~i 19 4y . <br />Certified Mail No.: / r <br />Return Receipt Requested <br />Signature of Person Serve <br />if personal service <br />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 />Operator <br />By <br />Date <br />(Signature) <br />19 <br />5/90 <br />0311(f) <br />