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STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAW FORM <br />In the matter of File No. M- - , Permit/Permit <br />Name of Ope/j'ator/Applicant and Site: (~' o ~ rp,-~,n ~ <br />Q ~i O _ Ar,~ n __`7`n17 ~ - ~i'n gyn.. ~ _- ~. n O_ _ ~ ~ <br />~~equest I be withdrawn from party status <br />I request I be withdrawn from party status and I wish to address the Boazd at the formal hearing, if <br />held, as a non-party <br />(Please note that if all objecting parties withdraw rior 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not obligated to consider any issues raised by a party that has withdrawn.)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 become a party or withdraw as a party in this <br />matter, please contact the Division for information on application status. <br />(Please <br />Printed <br />if you have or wish to have party status, thank you.) <br />a~L1 ' ~ ~ ,~-?L.l <br />Home Phone # <br />c~)~ ~.~ . S'~ <br />Work Phone # <br />FAX # <br />---~~~~ <br />Date <br />cuv_ Srare r., rn.ie <br />