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• <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. C-81-011 <br />C.O. N0. <br />N.O.V. NO. C-88-011 <br />~c <br />~ III IIIIIIIIIIIIIIII <br />999 <br />1. ~ i?3~ <br /> <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 thereo first c ass postage prepaid in the UniTt~ States mails at Denver, <br />Colorado, addressed to the operator at the address above, on March 29 _, <br />19~g. <br />Certified Mail No. P 494 856 685 <br />Return Receipt R q sted <br />ignature o erson erve i <br />if personal service <br />Print Name and Title Print Name and Tit e <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 />g~ ~~~ ,~~~~~ ~ <br />Operator <br />~,~~~~` <br />By <br />-~~ignature <br />Date ~-~ 19~~` <br />(5/85) <br />Doc. No. 251 <br />