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STATE OF COLORADO <br />NIINED LAND R,ECLAM9.TION BOARD <br />PARTY STATUS WITHDRAW FORM <br />In the matter of File No. M- 2005 _ 012 , PemutlPermit Amendment Application. <br />Name of OpeiatorlAppliCant and Site: Nick H. Gray jGray Pit #2 Sand and Gravel Mine <br />x I request I be withdrawn from party status 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_ I request I be withdrawn from party status and I wish to address the Board at the formal heazing, if <br />held, as a non-party <br />(Please note that if all objecting parties withdraw rior to the date set for the Board's consideration of the <br />application, the application may be approved by the Office and no Board hearing held. Thus, there will not be <br />an opportunity for any person to address the Board on any issues related to the applicaton. Also, the Board is <br />not obligated to consider any issues raised by a party that has withdrawn.) <br />Regardless of a pally status, the Division thoughtfully considers each issue submitted in writing to the Division and <br />provides a response to those issues in the Division's "Rationale for Recotttmendation ". The "Rationale" is available to <br />any person by contacting the Division. For persons who do not wish to become a party or withdraw as a party in this <br />matter, please contact the Division for information on application status. <br />(Please provide the following information if you have or wish to have party status, thank you.) <br />Lazy ACorporation/Gbrdon F. Autry <br />Printed i3ame <br />72834 Kinikin Road <br />Address <br />Montrose, CO <br />City, State <br />8140 <br />' Zip Code <br />( 970 ) 252-0889 <br />Home Phone # <br />( 970 1 249-8346 <br />Work Phone # <br />9~ 70 ~ 249-8346 <br />FAX # <br />August 22, 2005 <br />Date <br />