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J 1 ~ 1 !; V: I.ULUKAIJU <br />«NED LAND RECLAMATION~ARD <br />PARTY STATUS REQUEST FORM <br />In the matter of Fik No M- t q7q-15R , Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: ('o~nrarin c;ty atrnAnlitan Oistri - <br />1]QUntain Shadows Pit Conversion Application <br />~ 1 request that I be named as a party <br />I request that I not be named as a parry <br />I request to be withdrawn from party status 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 oC 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 oC the public. <br />For peop{e 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 />Eriwa rrl .1 fa rduno <br />Printed Name <br />P 0 E9x 147x1 <br />Address <br />Colorado Ci <br />City, State <br />CO 81019 <br />Zip Code <br />E-Mail Address <br />Signature <br />(719 1489-2F172 <br />Homc Phone # <br />( 1 Lama as above <br />Work Phone # <br />( 1 - (]191 578-0478 <br />FAX # <br />Aoril 7, 2000 <br />Date <br />If you are requesting to be named as a party, please btietly describe below: <br />1. how you maybe affected or aggrieved by the Board's decision in the matter referenced above, <br />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 />Please see a photocopy of my letter to Mr. Oehler dated April 7> 2000, <br />attached to this Party Status Request Form. <br />