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,~ ~ :> " <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT NO.: r"~- s~-'U,! <br />C.O. NO.: <br />N.O.V. NO.: C'rZ'iy+ <br />I hereby certify that I served a copy of the foregoing NOTICE OF <br />PROPOSED AMOUNT OF CIVIL PENALTY on the operator therein described <br />by depositing a true copy thereof first class postage prepaid in <br />the United States mails at Denver, Colorado, addressed to the <br />operator at the address above, on r?,,o„3T (o /y~2 <br />' J <br />Certified Mail No.: I ~~`~ i7'' ~7'z <br />Return Receipt Requested <br />,__., ~ <br />Signature of Person Served y (Signature) <br />Print Name and Title Pr1nt'Name and Title <br />REQUEST FOR CONFERENCE <br />The operator above described hereby requests an assessment <br />conference as permitted by C.R.S. 34-33-123(8). <br />operator <br />By <br />(Signature) <br />Date 19 <br />c:\wn51\oroppen <br />..__..~ .._ _ .. A~ CI <br />