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STATE OF COLORADO <br />"' NIINED LAND RECLAMATION BOARD <br />'PARTY STATUS WITHDRAW FORM <br />In the matter of File No. M-~- ~.~ . Petmit/Pertnit Amendment P <br />Name of Operator/Applicant and Site: ~ RA. - =(w~ n CF~rQr,rrz~mn ~ <br />I request I be withdrawn from parry status <br />_ I request I be withdrawn from party status and I wish to address the Boazd at the formal heazing, if <br />held, as anon-party <br />(Please note that Ii l~ objecting parties withdraw rior to the date set tot the Board's consideration o[ the <br />application, the application maybe approved by the 087ce and ao Board hearing held. 1]tns, there wi0 nobbe- <br />an opportunity for any person to address the Board on any issues related to the application. Also, the Board is <br />not obSgated to consider any issues raised by a party that has withdrawn.)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 becotrx 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 />Printed Name <br />Address <br />City, Stan Zip Crate <br />E-Mail Address <br />Signature <br />C~ <br />Home Phone # <br />(-) <br />Work Phone # <br /># <br />Date <br /> <br />MAR 2~, 2006 <br /> <br />'-r1) t„vy~on of Minerals ana GaobCv <br />