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-~tAY-05-99 WED 1229 PM D~URANGO FIELD OFFICE FAX N0. x+247+5104. P, 05 <br />VrJVVVVJ''~_/LI I }F LnW-l~CIJ~LI"IW ~"" }JJ rU..., 1'Ihfl tlIJ JJ U'J•JJ <br />STATE OF COLORADO <br />~ MINED LAND RECLA)VIATION BOARD <br />~ PARTY STATUS REQUEST FORM <br />____ I request that I be named as a patty <br />X I request that I riot be named as a party <br />.__, I requesCto be wi hdrawn from party status <br />In the matter of File Na, M- X19. o.2s, <br />Received <br />MAY 1 ~ 19Sg <br />~~n9o Fieitl <br />~iv>obn o/Miners 8 G~ ~ <br />i SoAit~rG E,gG~ E G'K.F~c c Pry ~ ESA ~aaH7~ <br />Regardless of your status, please fill in your same and address so the Aiviaion can send you <br />Information on this matter, <br />/Gil df• /~~/lam <br />Printed Name <br />Address <br />G-/~~4,r~0 ,T~ ~Tr ur Ca ~iSos <br />City, State Zip Code <br />Signature <br />970) ,7~-_YJ~ ~ <br />I~Iome Phone # <br />( 21a) .2~ 3-fG~ Z <br />Work Phone # <br />FAX # <br />S- G - y' ~ <br />Date <br />If you are requesting to be named as a party, please briefly describe below how you maybe <br />affected or agsrieved by agency action in th ~13~.a;ze+':=anced above. Insl de st tgc~P~.o; ____________^ <br />your opposition or support to t to matter, You may attach a written statement to this form instead <br />of filling in tilt space below, Include a specific description of the issues that you feel need to be <br />addressed at the final hearing before the Mined Land Reclamation Soard. <br />