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STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAW FORM ~ <br />--- ~ ./ <br />In the matter of File No. M-- " ~ _~ ~-,-1Pe~r nit Amendment App~ation. (~ (~(il. ~a l <br />Name of Operator/Applicant and Site: ~ r~C ~t/ ; ~ 1„:- . ~ ~~„~rai ~'Ja'' <br />" - I request I be withdrawn from party status <br />I request I be withdrawn from party status and I wish to address the Board at the formal hearing, if <br />held, as a non-party <br />(Please note that if all objecting parties withdraw nu •or to the date set for the Board's consideration of the <br />application, the application may be approved by the Office and no Board hearing held. Thus, there will not be <br />an opportunity for any person to address the Board on any issues related to the application. Also, the Board is <br />not obligated to consider any issues raised by a party that has withdrawn.) <br />Regazdless of a party status, the Division thoughtfully considers each issue submitted in writing to the Division and <br />provides a response to those issues in the Division's "Rationale for Recommendation ". The "Rationale" is available to <br />any person by contacting the Division. For persons who do not wish to tsecome a party or withdraw as a party in this <br />matter, please contact the Division for information on application status. <br />(Please provide the following information if you have or wish [o have party status, thank you.) <br />Printed Name Home Phone # <br /> <br />Address <br />_~v~ ~,~ G o ~ G ~~3~ <br />City, State // ~ Zip Code ,G <br />Signature <br />Work Phone # <br />FAX # <br />/3 ~UG o?~ <br />Date <br />~Ms~~Oian T ~~Op~ <br />noE~~ ~aS~G o <br />off, <br />