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STATE OF COLORADO ~'t~~, <br />MINED LAND RECLAMATION BOARD ~,.. Saco FjG <br />PARTY ST~TUS W~HDRAW FORM b~~~o~oR~` l~~~FQ <br />~r9.a! '°~es <br />In the matter of File 1'.'0. n'- %qT7- / 3 ~ , Perati e.-:rtit Ames'.`r!ent Application. d'a~e , <br />Name of Operator/Applicant and Site: CI[~cc s ~/~. ~!J <,~~a ,, Inc- ~ a rt e C~,v, ~o~, °. <br />I request I be withdrawn from party status 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I request I be withdrawn from party status and I wish to address the Boazd at the formal hearing, if 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 withdraev~ ;;riot to the date s2t.foLthe Board's.consideratiar,-of-l~+°----- <br />----appllca:"son; rbe apTca t~anay be approved by-the Office and no Board hearing held. Thus, there wig: reot 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not obligated to consider any issues raised by a party that has withdrawn.)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 />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 for Recommendation ". The "Rationale" is available to <br />any person by contacting the Division. Forpersons 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 provide the following information if you have or wish [o have patty status, thank you.) <br />F~,~ty <br />Printed Name Home Phone <br /> <br />City, State ' . ~ ~ Zip Code <br />E-Mail Address /~ ,, <br />Signature <br />Work Phone # <br />FAX #i <br />~'/' o ~; <br />Date' <br />70 (~ /~~ tS' / <br />