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1 <br />1, <br /> <br />STATE OF COLOR~D(~ <br />N ED LAND RECLAMATION ARD <br />PARTY STATUS FORtVi <br />2ov I ~~o ~ <br />In the matter of File No. M-~- , PermidPermit Amendment Application. <br />Name of Operator/Applicant and Sit~_ th~ T~tM~ `~,-(- <br />I request that I be named as a party <br />_ I request that I not be named as a party <br />_ I request I be withdrawn from party status <br />I wish to address the Board at the formal <br />hearing, if held, as a non-party <br />I understand that I hra~ve party status (o~ <br />q5 ~cr ~~15-fT't.{'L.r ro~ ~qi ~ S Yr'~r~~15 th, `.^' . <br />(Please note that if all objecting parties withdraw rip Or t0 the date set for the Division's recommendation for <br />approval or denial, there may not be an opportunity for any person to address the Board on any issues re]ated <br />to the application. If all objecting parties withdraw their objection after the above referenced date, the Board <br />may still hold a formal hearing, however the Board is not obligated to consider any issues raised by a party that <br />has withdrawn.) <br />Regardless of a party 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 Recommendation ". 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 starus. <br />(Please provide the following information if you have or wish to have party status, thank you.) <br />~nr~ ~i, ~/t Sow i ~ <br />Primed Name <br />°I Zs 5 r ~~. W1~ ~ 20b <br />Addrness 2 <br />~.(~~'-~7 C~ 4SI JZ f <br />City, State Zip Code <br />atgnature <br />Home Phone # <br />~v) sus-262X <br />Work Phone # <br />7~7) 57,5 -2608 <br />FAX # <br />2 i ~U, ~ <br />Date <br />If you are not now a party and you wish to be named as a party, please provide the following: <br />• How you may be affected or aggrieved by the Board's decision if the Board decides to approve the application. <br />(Please attach additional pages if needed) <br />Please explain your opposition to the matter, including a specific description of the issues that you feel need to be <br />addressed at the Formal Board Hearing and why. <br />(Please attach additional pages if needed) <br />