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RECEIVED <br /> OCT 312016 <br /> STATE OF COLORADO DIVISION OF RECLAMATION <br /> MINED LAND RECLAMATION BOARD MINING&SAFETY <br /> PARTY STATUS WITHDRAW FORM <br /> 4- <br /> In the matter of File No. M-p - ,Permit/Perm t Amendn}ent Application. <br /> Name of Operator/Applicant and Site: i +— <br /> -- �/ _ <br /> /_I request I be withdrawn from party status 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 I request I be withdrawn from party status and I wish to address the Board at the formal hearing, 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 withdraw prior 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 a party that has withdrawn.)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 Home Phone# <br /> Ad rs s Work Phone# <br /> City, State Zip Cod FAX <br /> y <br /> Gf<iltS t-J, ; �� f� ate (�-0t' ' <br /> E- z it Address C e J Date <br /> Signature <br />