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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- 1995 - 0 a 9 , Permit/Permit Amendment Application. <br /> Name of Operator/Applicant and Site: Hl cN MouwrA1^► Plltiw6 CO. , IBC <br /> AL A4A PcaC-Jl /yl106 <br /> 1� 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 a person or an entity that has withdrawn as a party.)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 /> Printed Name Home Phone# <br /> 131 3 514ffAAtJ 5T.J, SLIJTE 8� (303 ) 86'6`3581 x 9;07 <br /> Address Work Phone# <br /> [),CAI VC& C O 8 0-Q3 ) <br /> City, State Zip Code FAX# <br /> Coy.,^/. wATSO-I' 0 STATE. 60. vs 3/i <br /> E-Mail Address Date <br /> Signature <br />