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RECEIVED' ' - <br />FEB 2 3 2018 <br />DMS -ON OF RECLAMATION <br />STATE OF COLORADO KNINGAND SAFEIY <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAWAL FORM <br />In the matter of File No. M-joJ- 036 , Permit/Permit Amendment Application - <br />Name of Operator.'Applicant and Site: Loyeltuict &a( <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a person or an entity that has withdrawn as a party.)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 />1P, TENstn! <br />Printed Name <br />Address <br />Lct4e ii ..Co S: -S <br />City, 5tate Zip Code <br />J er15ekk_. 1r�3q �c Il�ct I�[a� <br />E -Mail Address' <br />Signature <br />iK <br />( qZ) 1-18q_7826 <br />Home Phone # <br />Work Phone # <br />FAX # <br />Date <br />