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III IIIIIIIIIIIII III <br />999 <br />_,, <br />MINED LAND RECLAhIATION DIVISIOi`J <br />CEkTIFICATE OF SERVICE <br />N.O.V. N0. 83-3n <br />I Hereby certify that 1 served a copy of the foregoing <br />OF CIVIL PEtJALTY on the operator therein described by <br />upon the operator or its representative at <br />Colorado on 19_, or K <br />copy thereof first class postage prepaid in the United <br />Colorado, addressed to the operator at the address abo <br />1983 . <br />u = ~ 1 -" i~~~~ <br />,,., ..~~ <br />NOTICE OF PROPOSED AMOUNT <br />(a)* personal service <br />u)* by depositing a true <br />States mails at Denver, <br />~e, on D?cei~iber 5 , <br />Certified Mail No. P t91 l~4 263 <br />it ,~L~--- <br />l~rynature) <br />Ilan F1,ithe~r~ <br />tJame Printed <br />* ---- Check applicable method of service. <br />REQUEST FOR COiIFERENCE <br />The operator above described hereby requests an assessment or settlement <br />conference as permitted by C.R.S. 34-33-123(3). <br />/' , <br />" " r.. <br />Operator <br />By <br />Siynatyre <br />Date - ... r <br />(1/53) <br />19 " ,' <br />Uoc. No. 251 <br />