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~.. ~ <br />' ~• <br />.Jf, <br />LERItFtE9_T~IlF~`Lgv_i~.E <br />I hareoy certify that I served a copy of the foregoing <br />NOTICE OF PP.JPOSED AMOU!li OF CIVIL PENALTY on the operator <br />therein described by ______(a)= personal service upon the <br />operator or its representative at ______________________ <br />____~_~___ _ _. Colorado on <br />l9___, or ___(uy by depositing a true copy thereof first <br />class postage prepaid in the United States mails at Oenver, <br />Colorado. addresad to the operator at the address above, on <br />-~ =`~=lam -Jt-----' 19_ ~_. <br />Sia~~ture <br />`~'~pS---I~L-Yrc~1 ------ <br />Name Printed <br />Y -- Lheck applicable method of service. <br />RE9l~E~I FQa L4~EHEvEE <br />The operator above described hereby requests an assess- <br />ment or settlement conference as permitted by C.R.S. 34-33-123(8). <br />Operator <br />e y--------- <br />(Signature) <br />Date <br />LNR/L+L000S/lCE <br />, 19 <br />