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_, <br />• <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />I hereby certify that I <br />PROPOSED AMOUNT OF CIVIL <br />by depositing a true co <br />the United States mail <br />operator at the address <br />PERMIT NO.:C-81-022 <br />C.O. NO.: <br />N.O.V. NO.:C-93-117 <br />served a copy of the f <br />PENALTY on the operator <br />py thereof first class <br />s at Denver, Colorado, <br />above, on September 15, <br />oregoing NOTICE OF <br />therein described <br />postage prepaid in <br />addressed to the <br />1993. <br />Certified Mail No.: P 296 527 488 <br />Return Receipt Requested <br />-D (Signature) <br />Signature of Person Served <br />(If personal service) <br />Print Name and Title <br />Larry P. Routten. Assessment Officer <br />Print 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 />