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~: <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-002-80 <br />C.O. NO. <br />N.O.V. N0. C-86-024 <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 />Signature of Person Served <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 />~e, on April 14 , <br />Certified Mail No. P 169 876 268 <br />Return Receipt Requested <br />Signature <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 />By <br />Signature <br />Date 19 <br />Doc. No. 251 <br />