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'~' ~• • • <br />r <br />CskllFis.alE_?F_~s~~1~.L <br />[ r~ereoy certify that I served a cony of the foregoing <br />wJTICE DF P~JPDSEJ AMOUNT JF CI'JIL PE"JALTY on the operator <br />tnerein descried by ______(a)~° personal service uaon the <br />operator or its rarresentative at ________________________' <br />------------------ ------, Colorado on ----------------' <br />19___, or __~.__(;.~) = by d??os i ti.'ly j true copy thcr2of f i rst <br />class postay= araaaid in the l;nitEd Statas Tails at Denver, <br />Coloracor sdUrasad to 'hc o~ar~tor at t`+e address abova, on <br />-__- September 4 __-_ ~ 1 0 81 , <br />x'11, <br />--~..w~----- ~ ~y=~l~` --------------- <br />Name Printed <br />• -- Check applicable method of service. <br />( Certified Mail) <br /> <br />The operator aoove described hereby requests an assess- <br />oent or sattle~nent conference as ?emitted by C.R.S. 34-33-123(5). <br />~ i <br />rperator // <br />.; <br />B ~~~\ ` -~ <br />y--- yy- ~_~~-- =------------------------ <br />(Sign~ture) <br />i <br />Date '~~ -- ~~ _--_-' 19~~ <br />CVR/L.10~J5/ICE <br />