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STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD RECEIVED <br />PARTY STATUS WITHDRAW FORM QPR 18 2U03 <br />in the matter of Pzle No. M-~- /a~ , Pemnit/Petarit Amendment <br />Name of Operator/Applicant and Site: S~i~sz.> G/onls>'?uer'ro.c/ /Boye <br />I request I be withdrawn from party status <br />I request I be withdrawn from party status and I wish to address the Boazd at the formal hearing, if <br />held, as a non-party <br />(1?lease note that if all ob jecting parties withdraw rior to the date set for the Board's consideration of the <br />application, the application may be approved by the Of£ce 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 application. Also, the Board is <br />not obligated to consider any issues raised by a party that has withdrawn.) <br />Regardless of a party starus, the Division thoughtfully considers each issue submitted in writing to the Aivision and <br />provides a response to those issues in the Division's "Razionale for Recommendation ". The "Rationale" is available to <br />any person by contacting the Dtvision. For persons who do not wish to become a party or wi[hdraw 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 ro !rave pazty status, thank you.) <br />~A/r1F5' B• /iAN~uE~. <br />Printed Name <br />ya3 Tai GC~,9 y <br />Address <br />/,~JE,srel..~r-FE ~D ~Jds~ <br />City, Stale Zip Code <br />E-Mail Address <br />r ~i9~ 7P3 ~93~q <br />Home Phone # <br />Wo( rk Phone # ~9 <br />(i) A/A <br />FAX # <br />f}P2.c. !~' ~ aao3 <br />pate <br />£ 'd W02i~ Wd£P' Z £00Z-8 L-V <br />