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• III IIIIIIIIIIIII III <br />999 <br />MINED LAND RECLAMATION DIVISION _ <br />CERTIFICATE OF SERVICE <br />__ ;~. <br />~ PERMIT N0. C-84-067 <br />C.0. N0. <br />N.O.V. N0. C-86-037 <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 ,, o~~ <br />copy thereof first c ass postage prepaid in the United <br />19 $o6rado, addressed to the operator at the address abo~ <br />ignature o erson 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 />Certified Mail No. P 169 876 322 <br />Return Receipt Requested <br />U/l a~_ _ <br />S~ignaturej~ <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 />,- . . <br />Doc. No. 251 <br /> <br />By <br />Signature <br />Date 19 <br />