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x <br />r~ <br /> <br />DIVISION OF MINERAIS AND GEOLOGY <br />CERTIFICATE OF SERVICE <br />PERMIT NO.: C-84-065 <br />C.O. NO.: N/A <br />N.O.V. NO.: C-94-028 <br />I hereby certify that I served a copy of the foregoing NOTICE OF PROPOSED AMOUNT OF <br />CIV1Z PENALTY on the operator therein described by depositing a tnle copy thereof fast class, <br />postage prepaid in the United States mails at Denver, Colorado, addressed to the operator at the <br />address above, on October 27, 1994. <br />Signature of Person Served <br />if personal service <br />Print Name and Title <br />David A. Berry. Assessment Officer <br />Print Name and Title <br />REQUEST FOR CONFERENCE <br />Operator <br />By <br />(Signature) <br />The operator above described hereby requests an assessment or settlement conferenfe as permitted by <br />C.R.S. 34-33-123(8). <br />Date <br />19 <br />mf:\oss\aiw\9421n <br />Certified Mail No. P 296 608 164 <br />