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III ~Illlll~l~~ll 111 MIiTED LAND RECLOMA ONOB~RD RECEIVED <br />PARTY STATUS REQUEST FORM SEP O 1 1999 <br />livision of Minerah & Geology <br />In the matter of File No. M- 77- / q6, Permit/Permit Amendment Application. ~ <br />Name of Operator/Applicant and Site: .~/a.rcr /~oe.~' //a,/inv~j~ REQ/ -/Lljx - <br />~uer~ Visfc /~/t <br />I request that I be named as a party <br />I request that I not be named as a party <br />?request tC be Withdi aWTi f Gi?~ party SidtUs <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 />the Board 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 otMinerals and Geology. <br />~; cryacrot '¢ SUS.c <br />Printed Name <br />P.d. Box y7 9( <br />Address <br />$vena. Vises CD S/2// <br />City, State Zip Code <br />WaL~EMTXJS{1aV G~ CffAFFEF.NcT <br />E-Mail Address <br />7/91 393 - 6 588 <br />Home Phone # <br />(x/9'1395 -1s-oa ~svsAN~ <br />Work Phone # <br />FAX #~'7 / 9) /~.~ 9S - 6.1'8 d' <br />~MUSr cau. i=iiefr t <br />RE7rr~r-3'T FnX 'TL 8t 7-+~2NED oN~ <br />Signature <br />~-.3a-9p, <br />oats <br />If you are requesting to be named as a party, please briefly describe below: <br />1. 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 />&~vn~i~r~ oT-fhe_~~~^a/ uck or~Er<fion _ (~Ve onPase '7`/~P <br />