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III IIIIIIIIIillllll <br />DIVISION OF MINERALS AND GEOLOGY <br />CERTIFICATE OF SERVICE <br />PERMIT NO.: C-84-063 <br />C.O. NO.: <br />N.O.V. NO.: C-93-149 <br /> <br />J",'1' a 1°94 <br />Ci..__... ,._.~,_..~,. <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 /~-/a-F~(J3 <br />Signature of Person Served <br />if personal service <br />Print Name and Title <br />Certified Mail No.: P 296 525 776 <br />Return Receipt Requested <br />~.~~~,6~~ ~~ <br />" (Signature) <br />Daniel I. Hernandez, Sr. Env. Prot. Spec. <br />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 />~.~5~~/dam ( o~3L L~~It ,.f~•-_ <br />Operator +/ <br />,~ <br />By <br />ignature) <br />Date /-? - 19 ~~ <br />DIN/scm <br />9564E <br />