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f. <br />iiiiiniiiiiiiiiiii <br />999 <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-047-81 <br />C.O. N0. N/A <br />N.O.V. N0. C-85-056 <br />r <br />,~ <br />N <br />- , <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 Uni~ States mails at Denver, <br />Colorado, addressed to the operator at the address above, on June 25 , <br />19~. <br />ignature o erson erved <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 652 676 369 <br />Return ReceiptCRequested <br />vz ~.circ/f~ <br />-~$ign ure <br />RD <br />Print Name and Ti le <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 />(5/85) <br />Operator <br />By i~~l k ~ mod. '~ <br />Signature <br />Date ~- /~ 19 4•~ <br />Doc. No. 251 <br />