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<br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />~ PERMIT N0. C-025-81 <br />C.0. N0. N/A <br />N.O.V. N0. C-85-037 <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 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 Jurre li <br />19 85. <br />ignature o erson erved <br />if personal service <br />Print Name and Title <br />Certified Mail No. P 652 676 051 <br />Return Receipt Requested <br />~~~ ~ ~- <br />ignat re <br />Michael S. Sava a Assessment Officer <br />Print Name and Tit e <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 19 <br />Doc. No. 251 <br />