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MINED LAND RECLAMATION DIVISION #ECEIVED <br /> CERTIFICATE OF SERVICE J A N P, lj1;a <br /> PERMIT NO. C-81-017 MINEC) LANU <br /> REC�L.e�MATIC1,k <br /> C.O. N0. <br /> N.O.V. NO. C-89-033 <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 fi rst class postage prepaid in the United States mails at Denver, <br /> Colorado, addressed to the operator at the address above, on December 21 , <br /> 19 89. <br /> Certified Mail No. v 767 447 543 <br /> Return Receipt R , uested <br /> Signature of Person Served (Signatur94 <br /> if personal service <br /> Michael S. Savage Assessment Officer <br /> Print Name and Title Print Name and Title <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 /> ` ign ure <br /> Dated 19�y <br /> (5/85) <br /> Doc. No. 251 <br />