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sTaTE o~ coLaR~o <br />l1LYED L~~ xZECL:1~`L~TION BOARD <br />PARTY ST?,TtiS ~~ZTHDR-~,tiV FOR'~I <br />In the matter ai" File ~io_ ;v1- - PetitiUPermit .~.tnendtnent Agglication. <br />ti:.me of OaetatorlApglicaat and Site: <br />I request I be withdrawn from parry stains <br />,___ I request I be withdrawn uom paay status and I •~z•ish to adcLess the Beazd a[ the formal hear~g, if <br />held, as ahon•party__ _- _.._... _._ _ <br />(Please note that if all objecting parties withdraw riot 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 opportun9ty for any person to address the Board an any issues rotated to the application. A]so, the Board is <br />not obligated to consider any "sues raised by a patty tact has ~cithdrawn.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in ~xziting to the Divisicn and <br />provides a response to those issues ir. the Division's "Rationale for Recommendation ". The "Rationale" is available to <br />any person by contacting the Division. Foz persons ~x•ho do not wish to become a batty or withdrav+ as a party ir, rtiis <br />matter, please contact the Division for ituartnation on application scams. <br />(Please provide the following information if you have or wish to have party status, thattY. you.) <br />Pti~red Vame <br />.~ddre;s <br />Eliry, Sato <br />E-Mail :1dd;ess <br />Some Phone ;€ <br />Work Phone <br />~ )_ <br />Zip Codc ::~X =k <br />Date <br />Sigrari <br />