Laserfiche WebLink
• X25 <br />• <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-81-010 <br />C.O. N0. <br />N.O.V. N0. r_Qu a~ <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„„ary F , <br />19 88. <br />ignature o erson erve <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 051 874 864 <br />Return Receipt Req~este <br />.~ ~- <br />ignature <br />Michael S. Savage, Assessment Officer <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 />(5/85) <br />By <br />Signature <br />Date' ~ 19 <br />Doc. No. 251 <br />