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STATE OF COLORADO <br />MINED LAND RECL A3 1ATION BOARD <br />PARTY STATUS R'[THDRAWAL FORM <br />In the matter of File No. M-20-16,06 _ Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: '6 ,e 5 t �` C v Jai C— Y- e <br />rtA ra <br />�. tAVhereby withdraw as a party to thi; 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 Mthout 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a person or an entity that has withdrawn as a paM-.) <br />Regardless of a party stags, the Division thcughtfitlly 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 />Robetrf E. a v e m i a lewc e r r 3U3 q.57 �,3 g_!L <br />Printed Naa ���� Home Phone # <br />Address 621 Work Phone # <br />F& v, G- k e fo. e to j/'Ct � b (3-639 _)S67 <br />City, StateZip Code FAX # <br />r 'Fie W )41 e Ir' 12 <br />e fCz vt 1-t ez V't 016 <br />E-Mai)?�doress�J ' /' _ Date <br />