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III IIIIIIIIIIIII III <br />MINED LAND RECLAMATION DIVISION <br />CERTIFICATE OF SERVICE <br />PERMIT N0. None <br />C.O. N0. C-86-046 <br />N.O.V. N0. <br />~~,y ~~ <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 first c ass postage prepaid in the Unit 3 States mails at Denver, <br />Colorado, addressed to the operator at the address above, on June 26 , <br />1986 . <br />Certified Mail No. P 169 876 378 <br />Return Receipt Req ested <br />ignature o erson Served ~' ignature <br />if personal service <br />ffi r <br />Print Name and Title Print Name and itle <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 />e . i ~e~- ~ /e{ 2 C~. c. r.-aj/ <br />Operator <br />~ ~ <br />8Y ~~~ , r c4; ~~ f'l%~2r r <br />-~ Signature <br />Date c_'....c:, io 19 9c <br />(5/85) <br />Doc. No. 251 <br />