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-4 -CEIVEI. <br /> MINED LAND RECLAMATION DIVISION NOV -�) M 1991 <br /> CERTIFICATE OF SERVICE Mined L-anci <br /> PERMIT NO. : C-81-017 <br /> POnlamatinn i)ivi <br /> C.O. NO. : <br /> N.O.V. NO. : C- 018 <br /> I hereby certify that I served a copy of the foregoing NOTICE OF PROPOSED AMOUNT <br /> OF CIVIL PENALTY on the operator ein described by depositing a true copy eof first <br /> class postage prepaid in the United States mails at Denver, Colorado, addressed to <br /> the operator at the address above, on November 6, 1991 . <br /> Certified Mail No. : P 860 179 256 <br /> Return Mail Receipt Requested. <br /> Signature of Person Served , (Signature) <br /> if Personal Service <br /> L <br /> Print Name and Title Print Name a d Title <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 /> gy <br /> Signature <br /> Date 1991 <br /> 9284F/gaw <br />