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<br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-012-81 <br />C.O. N0. N/A <br />N.O.V. N0. C-85-042 <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 * by depositai~ng a true <br />copy thereof first c ass postage prepaid in the UniY3 States maJiune 1/Denver, <br />Colorado, addressed to the operator at the address above, on , <br />1985. <br />ignature o erson erve <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 652 676 052 <br />Return Receipt Requested <br />u~a~cJ//~ ~~ <br />igna ure <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 />Operator <br />(5/85) <br />By <br />Signature <br />Date <br />19 <br />Doc. No. 251 <br />