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~ sTA' IIIIIIIIIIIIIIIIIII DO + <br />MINI,D LANL ,....,.,ess__ ~N $OARD <br />PARTY STATUS REQUEST FORM <br />_ I request that 1 be named as a party <br />aECEIVED <br />I request that I not be named as a party 1999 <br />~ MAY 21 <br />I request to be withdrawn from party status <br />,livision of Minerab & Geow9Y <br />In the matter of File No. M-~~7 -~,Z: <br />For people who do not wish to become parties in this matter, information on the permit <br />application proce~s can be requested from the Division of Minerals and Geology. <br />Zip Code <br />f <br />Home Phone # <br />f ) <br />Work Phone # <br />I ) <br />FAX # <br />E-Mail <br />/..~rr <br />St ~ ature <br />,S"/~ t X44 <br />Date <br />If you are requesting to be named as a party, please briefly describe below how you may be <br />affected or aggrieved by agency action in [he matter referenced above. Include a statement of <br />your opposition or support in the matter. You may attach a written statement to this form instead <br />of filling in the space below. Include a specific description of the issues that you feel need to be <br />addressed at the final hearing before the Mined Land Reclamation Board. <br />