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---±~ <br />STATE OF COLORADO r III IIIIII~IIIIII III <br />MII~ LAND RECLAMATION B~ _C~' <br />PARTY STATUS REQUEST FORM MAy L5 2000 <br />In the matter of File No. M-(~~~ Permit/Permit Amendment Applica~~r~,OtPA~netals~~~ep109Y <br />Name of Operator/Applicant and Site: r~,(;., C,f~/~ETRaO,;L~ TA~tIo~T~6sNa~r~l 1 iT <br />I request that I be named as a party <br />I request that I not be named as a party <br />_ request to be withdrawn from party status <br />I understand that if I am not a party, my statements of concern or objection to this <br />application will not be considered during the review of the application, but I may address <br />t and on this matter at the final hearing, and may present my concerns as an <br />interested member of the public. <br />For people who do not wish to become parties in this matter, information on permit <br />application status can be requested from the Division of Minerals and Geology. <br />~NR2LES ~E~~EiiA - fr~,L <br />Pri ted Name <br />~(~ PLSK OU E ,ST <br />Ad ress /` <br />City, State Zip Code <br />r7i9 ~ ~`~l-dl8/ <br />Home Phone # <br />( 2 - <br />Work Phone # <br />( L - <br />FAX # <br />E- '1 Address <br />Signature ~ Date <br />If you are requesting to be named as a party, please briefly describe below: <br />I. how you may be affected or aggrieved by the Board's decision in the matter referenced above, <br />2. your opposition to the matter, including a specific description of the issues that you feel need <br />to be addressed at the final hearing. (You may attach a written statement to this form instead <br />of using the space below <br />