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j \/ RECEIVED <br /> 6\1 FEB 21 2020 <br /> DIVISION OF REV-,p,MAT° <br /> STATE OF COLORADO MINING AND SAFE <br /> MINED LAND RECLAMATION BOARD <br /> PARTY STATUS WITHDRAWAL FORM <br /> In the matter of File No. M- )(bet _10( - (p L((p , Permit/Permit Amendment Application. <br /> Name of Oper tor/Applicant a d Site: cam.± Wc.. S.tLi., C w tin`! <br /> 1v\C, —Brad�ov0\10‹-/...L. <br /> 0 <br /> I hereby withdraw as a party to this matter. <br /> XI 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 a person or an entity that has withdrawn as a party.)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 /> 141 Icl\&e.l 'W‘VON(‘A (3-1q ) D7 L-R16 <br /> Printe Name Home Phone# <br /> O. 5 S ( ) NO, <br /> Address, Work Phone# <br /> City,Walwbn 1 co eitc6s ( <br /> NJ/A <br /> State Zip Code FAX# <br /> hi r �+ i., noo <Coovt 0 0/ 143 I A c; <br /> E-Mail dr ss�� 1 f Date <br /> Signature <br /> 12 <br />