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M. Brown - M1990000.TIF <br />STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHI3RAW FORM <br />In the matter of File No. M-= , PertrtitlPermit Amendment Application. <br />Name of Operator/Applicant and Site: <br />I request I be withdrawn from patty status <br />_ I request I be withdrawn from party status and I wish to address the Board a[ the formal heazing, if <br />held, as a non-party <br />(Please note that iY all objecting parties withdraw riot [o 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 wiB not be <br />an opportunity Yor 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not obligated to consider any issues raised by a party that has withdrawn.)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 />Regardless 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 Eor 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 ovide fhe following information i(you have or wish to have party status, thank you.) <br />Printed Name Home Phone # <br />~~ Pax 9g3 ~ ~--- <br />Address <br />City, Sta tip Code <br />-Alai eas ' <br />Signature <br />Work Phone # <br />FAX # <br />/~a~ <br />Dam <br />Page 22 ~, <br />