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i <br /> C� <br /> AUG 3 0 2016 <br /> STATE OF COLORADO DIVISION OF RECLAMATION <br /> MINING AND SAFETY <br /> MINED LAND RECLAMATION BOARD <br /> PARTY TATUS WITHDRAWAL FORM <br /> In the matter of File No. M-A 00 - 0 1-7 i t�- , Permit/Permit Amendment Application. <br /> Name of Operator/Applicant and Site: L, G I✓v r t st �'a I )o rk <br /> �c.Sc��•�CC, <br /> ✓ I hereby withdraw as a party to this matter. <br /> I hereby withdraw as a party to this matter and, if the Board holds a hearing, I <br /> wish to address the Board at the formal hearing, if held, as a non-party. <br /> (Please note that if all objecting parties withdraw prior to the date set for the Board's <br /> consideration of the application, the application may be approved by the Office without the <br /> Board holding a hearing. In that event, there will be no opportunity 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 a person or an entity that has withdrawn as a party.) <br /> Regardless of a party status, the Division thoughtfully considers each issue submitted in writing <br /> to the Division and provides a response to those issues within its jurisdiction in the Division's <br /> "Rationale for Recommendation." The Rationale is available to any person by contacting the <br /> Division. For persons who do not wish to become a party or withdraw as a party in this matter, <br /> please contact the Division for information on application status. <br /> � .� —0o , P.lw C'i-1 L_ -74499 <br /> t i rw at LO km6- n n ) <br /> Printed Name (( Home Phone# <br /> io Ll -7 1-1v.J 1 J C O u.r% oc-CA Z 11 b <br /> Address ` Work Phone # <br /> LOtiGvhOh� <br /> City, Stater Zip Code FAX# <br /> -���-Cz <br /> E M Date <br /> Signature <br /> 12 <br />