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<br /> <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />N.O.U. N0. <br />I hereby certify that I served a copy of the foregoing <br />OF CIVIL PENALTY on the operator therein described by <br />upon the operator or its representative at <br />Colorado on 19 or <br />copy thereo first c ass pos age prepaid in the Unite <br />Colorado, addressed to the operator at the address abo <br />19~. <br />NOTICE <br />^(a} <br />b '` by <br />States <br />fie, on <br />OF PROPOSED AMOUNT <br />t personal service <br />depositing a true <br />ails at Denve l <br />Certified Mail No. <br />~. <br />Signa ure <br />ame Printed <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 />ignature <br />Oate 19 <br />(1/83) <br />Doc. No. 251 <br />