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- ,. <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />N.O.V. N0. <br />I Hereby certify that I served a copy of the foregoing <br />OF CIVIL PENALTY on the operator therein described by <br />upon the operator or its representative at <br />Colorado on 19 or ~ <br />copy thereof first class postage prepaid in the United <br />Colorado, addressed to the operator at the address abo <br />19~. <br />NOTICE OF PROPOSED AMOUNT <br />_(a)* personal service <br />o)* oy depositing a true <br />States mails at Denver, <br />re, on , <br />Return Receipt Requested <br />Certified Mail No. p 397 149 436 <br />ignatu <br />Susan Mowry <br />Name Printed <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 />By <br />ignatu re <br />Date <br />(1/83) <br />19 <br />Doc. iVO. 251 <br />