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STATE OF COLORADO <br /> MINED LAND RECLAMATION BOARD <br /> PARTY STATUS WITHDRAWAL FORM <br /> In the matter of File No. M-,;�,G t 7 - CIO l , PermitfPernut Amendment Application. <br /> Name of Operator,Applicant and Site: ' ` L00 Ar D C Gf:�-`SHfrvG �'�r�J�� �►� <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 a person or an entity that has withdrawn as a party.)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 /> '5.P, *�C,(i 2— s 72:q) QS�1, <br /> Printed Name Home Phone # <br /> Pg F9X i4,-�—, 1 1 <br /> Addr,4 ss Work Phone # <br /> vvr <br /> City, State Lip Code FAX 4 <br /> �ryaSS�c{c'�Ci��t tilta, �.c=y.1, <br /> E-iViail Addre;�s � Date <br /> Siff tore <br /> 12 <br /> • <br />