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UL <br />STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />t, PARTY STATUS WITHDRAW FORM <br />In the matter of File No. M- o / -D 1'7 , Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: A- 3u //i v�� 4gitc 'ml e <br />P;-/- <br />t/ I request I be withdrawn from party status <br />I request I be withdrawn from party status and I wish to address the Board at the formal hearing, <br />if held, as a non-party <br />(Please note that if all objecting parties withdrawrip or to the date set for the Board's <br />consideration of the application, the application may be approved by the Office and no Board <br />hearing held. Thus, there will not be an opportunity for any person to address the Board on any <br />issues related to the application. Also, the Board is not obligated to consider any issues raised by <br />a party that has withdrawn.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing to the <br />Division and provides a response to those issues in the Division's "Rationale for Recommendation". <br />The "Rationale" is available to any person by contacting the Division. For persons who do not wish to <br />become a party or withdraw as a party in this matter, please contact the Division for information on <br />application status. <br />(Please provide the following information if you have or wish to have party status, thank you.) <br />Printed Name <br />Home Phone # <br />-^-'' rt -ss <br />Work Phone # <br />City, State <br />U <br />Zip Code FAX <br />E -Mail Address <br />Date <br />Signature <br />