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•~ <br />;: <br /> <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-81-048 <br />C.O. N0. <br />N.O.V. N0. C-86-068 <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 the Unites States mails at Denver, <br />Colorado, addressed to the operator at the address above, on October 23 > <br />19~. <br />Certified Mail No. p 168 480 183 <br />Return Receipt Requested <br />ignature of Person Served Signatur <br />if personal service <br />Michael S. Savage, Assessment Officer <br />Print Name and Titre 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 />(5185) <br />By <br />Signature <br />Date 19 <br />Doc. No. 251 <br />