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• ~ <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. r-Ra-nhR <br />C.O. N0. <br />N.O.V. N0. r.-R~-nis <br />iii iiiiiiiiiiiiiiii <br />i~~~~~~ <br />JUN 11 1987 <br />i~EO~-"17~H710N DIVI510N <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 XX b * by depositing a true <br />copy thereof first c ass postage prepaid in the Unite States mails at Denver, <br />Colorado, addressed to the operator at the address above, on June 8 , <br />19~. <br />ignature o erson Served <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 168 480 017 <br />Return Receipt Reque.ted <br />~, <br />~f2~c~iatl .~~iva, <br />ignature <br />Poi rhaal ~- ca va4 Officer <br />Print Name and Tit e <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 />/`~ w C/~f%<C Ci/c/ll• Y ~2i0c'~i9.'ii~,. <br />Operator <br /><` <br />\\V \~ Signatur'e <br />Date c--r /o 19 ~7 <br />(5/85) <br />Doc. No. 251 <br />