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<br />MINED LAND RECLAMATION D N ISION <br />CERTIFICATE OF SERV ICE <br />PERMIT NO.: r..~i _mF <br />C.O. NO.: <br />N.O.V. NO.: C-84-014 <br />I hereby certify that I served a copy of the foregoing NDTICE OF PROPOSED AMOUNT <br />OF C N IL PENALTY on the operator therein described by (a)* personal service <br />upon the operator or its reepresentative at Colorado <br />on 19 or XX (b)* y epos ing a rue copy thereof <br />firs c ass pos age prepaid in the Uni ed States mails at Denver, Colorado, <br />addressed to the operator at the address above, on June 27 1989 . <br />ignature o erson erve <br />if personal service <br />riot ame an i e <br />Certified Mail No.: P 132 280 099 <br />Return Receipt Re es e <br />/P`li~ ~ <br />ignatur <br />Michael S. Savage Assessment Officer <br />rin Name an it 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 />i gnature <br />Date 19 <br />11/88 <br />0311 (f ) <br />