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-.~ . ! ~, ! ~ III IIIIiiiiilllllil <br />.~ <br />(~~RT jF jyAT~~F~=RV j~,F <br />I hzreoy certify that I s?rued a copy of the foregoing <br />ra~7TICE OF Pa~aDSED AMOU'1T DF CIVIL PE"~aliv on the operator <br />tnerain described by ______(a)= personal service upon the <br />operator or its representative at ___________ __-________ <br />------`-----------' Colorado on ------------- ' <br />19___. or _]~__(o)= Dy d?positing a true copy thereof first <br />class postage ;irepaid in the United States mails at Denver. <br />Colorado. addresad to the operator at the address above, oh <br />Sign tune <br />Name Printed <br />-- Check applicable method of service. <br />R~94E~i_F43_~2'±F,~s~~E <br />The operator aoove described hereby reques[s an ass?ss- <br />r.ant or settlement conference as permitted by C.R.S. 34-33-123(°). <br />~e ~i <br />Operator <br />(Sign ture) <br />Date _,~ c,__ 2-~-__, 19_~-l-! <br /> <br />LNR/Li10ODS/LCE <br />