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RECEIVL- "-- <br /> MINED LAND RECLAMATION DIVISICN SEP 211992 <br /> DIVISIUI` -,r <br /> CERTIFICATE OF SERVICE MINERALS <br /> PERMIT NO. : C-81-017 <br /> C.O. NO. : None <br /> N.O.V. NO. : C-92-025 <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 depositing a true copy <br /> thereof first class postage prepaid in the United States mails at Denver, <br /> Colorado, addressed to the operator at the address above, on September 15, 1992 . <br /> Certified Mail No. : P 880 733 347 <br /> Return Receipt Request_ <br /> Signature of Person Served / ign t <br /> if personal service <br /> David B / Senior Reclamation Specialist <br /> Print Name and Title Print Name and 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 /> By <br /> (Signature) <br /> Date r, l� 19� . <br /> DAB/scg <br /> 4840F <br />