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DIVISION OF MINERALS AND GEOLOGY <br /> CERTIFICATE OF SERVICE <br /> PERMIT NO. : C-81-017 <br /> C.O. NO. : C-93-145 <br /> N.O.V. NO. : <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 <br /> Certified Mail No. : P 296 526 032 <br /> Return Receipt Requested <br /> Signature of Person Served (Sign ure) <br /> if personal service <br /> Daniel I . Hernandez, Sr. Env. Prot. Spec. <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 19 <br /> DIH/scm <br /> 9436F <br /> 1 /3 <br />