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<br />r <br />,~ <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. r-Ra-n~F <br />C.O. N0. <br />N.O.V. N0. f.-R7-n 1'i <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 XX <br />copy thereof first c ass postage prepaid in the United <br />Colorado, addressed to the operator at the address abo <br />19~. <br />ignature of Person erved <br />if personal service <br />Print Name and Title <br />NOTICE OF PROPOSED AMOUNT <br />(a)* personal service <br />,b * by depositing a true <br />States mails at Denver, <br />ie, on June 8 , <br />Certified Mail No. P 168 480 017 <br />Return Receipt Reque~/sted <br />~i %~' <br />/i'~.c/1~vU ~~'s~ ~' <br />ignature <br />f i r <br />Print Name and Tit e <br />--- Check applicable method of service. <br />REQUEST FOR CONFERENCE <br /> <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 />