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STATE OF COLORADO <br /> MINED LAND RECLAMATION BOARD <br /> PARTY STATUS WITHDRAW FORM <br /> In the matter of File No. M-2016-085 , Permit/Permit Amendment Application. <br /> Name of Operator/Applicant and Site: Northern Colorado Constructors Inc. <br /> nnett Gravel Pit <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 I request I be withdrawn from party status 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 I request I be withdrawn from party status and I wish to address the Board at the formal hearing, 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 a party that has withdrawn.)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 Nar&e Home Phone# <br /> W ork Phone# <br /> ( ) <br /> ity, St to ip C de FAX <br /> Zg�ll� <br /> -Ma' d r s Dat <br />