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... <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERV <br />PERMIT N0. P-A1-015 <br />C.O. N0. <br />N.O.V. N0. r_RR_~no <br />I hereby certify that I served a copy of the foregoing NOTICE OF PROPOSED AMOUNT <br />OF CIVIL PENALTY on the operator therein described by _(a)* personal service <br />upon the operator or its representative at , <br />Colorado on 19 or ~ b * by depositing a true <br />copy thereof first c ass postage prepaid in tthe United States mails a Denver, <br />Colorado, addressed to the operator at the address above, on , <br />19~. <br />ignature o erson erve <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 708 596 301 <br />Return Receipt Re ues d <br />w ~~ <br />fig atu <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 />AME2/CftN SH/EL.d COf),L. G~OM/°fIN}~ <br />Operator <br />(5/85) <br />-eiLc_~~~y <br />~~~ Signature <br />~EGr EE2it,'E TTE <br />Date APL 7 19~~ <br />Doc. No. 251 <br />