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i_ ~.. ~ . <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />N.O.V. N0. C-84-177 <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 irs c ass postage prepaid in the United States mails at Denver, <br />Colorado, addressed to the operator at the address above, on , <br />19 <br />Certified Mail No. P 652 676 319 <br />Y <br />Sign ture <br />Susan Mowrv <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 />Signature <br />Date 19 <br />(1/83) <br />Doc. No. 251 <br />