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`Sea•13. 2004 3:O1PM Hale Friesen lLP <br />No•2522 P• 3 <br />'STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITITDRAW FORM .; <br />i <br />i <br />In the mattes of Pile No. M-j~- ~ ~" Pemvtipermit Amendment Application <br />Name of OperatorlApplicant and Site: A~~,~y~_>!ll,• d-~Ic. ~t'~' <br />I request I be withdrawn fzom patty status <br />_ I request,I be withdrawn from perky status and I wish to address the Board at the forulal hearing, if <br />• lteld, as a rion-PAY <br />(Please note that if <br />withdraw <br />-'app ca on, a ap"pTiw~ign mayTie approved by the Office and no Board hearin¢ held. Tht <br />-'-~tYoppo nt ox~any person o a ess a oard on any issues related to the application. <br />not obligated to consider any issues raised by a party that has withdrawn.) <br />the Board is <br />Regardless of a patty status, the Division thoughtfully considers each issue submitted is writing to the Division and <br />provides a response to those issues 3n the D'ivision's "Rationale for Recommendation ". The "Rationaye" is available to <br />any person by contacting the Division. For persons 'who do not wish to become a party or withdraw as a parry in this <br />matter, please contact the DiviSlon for information on application status. • , <br />(]?lease provide the following information if you have or wish to have parry stauts, (hank you.)• <br />Printed Name . <br />Address <br />aty, <br />Zip Code <br />(_~ __ <br />I•lome Phoae # <br />(-_) ~i <br />WorkPhone# j <br />C,~ <br />FAX # <br />t <br />Date <br />(,~"B>rit~ (~ -~-1+~.' ~k.G~-l~n.al~, S~u~. +~,ti.e,(c,i~lp <br />i <br />6(i ~tl~-t,~- <br />