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' • ~ ~II ~I~~I~~I~I~~~~~I _ STATE O); COLORADO RECFe~E® MINED LAND RECLAVI.~TION BOARD JUN 0 5 ?~~~ PARTY STATUS FOR1vI Division o/Minerals and Gealagy In the matter of File No. vt-~G'L'D - i s' S' , Permit/Permit Amendment Application. Name of OperatorlApplieant and Site: ~ocl-H MPFFsch he;d.v~ ,~i',+-ft,. 3>r~ a ~.nu < / ~.~,~ I request that I be named as a party I request I be withdrawn from parry s[atus I request that I not be named as a parry I understand that I have party status _ I wish to address the Board at the formal heazin~, if held, as a non-party (Please note that if all objecting parties withdraw np 'or to the date set Cor the Division's recommendation for approval or denial, there may not be an opportunity for any person to address the Board on any issues related to the application. If all objecting parties withdraw their objection after the above referenced date, the Board may still hold a formal hearing, however the Board is not obligated to consider any issues raised by a party that has withdrawn.) Reeardless of a party status, the Division thoughtfully considers each issue submitted in writing to the Division and provides a response to those issues in the Division's "Rationale For Recommendation ". The "Rationa]e" is available to any person by contacting the Division. For persons who do not wish [o become a party or withdraw as a parry in this matter, please con[act the Division for information on application status. (Please provide the following information if you have or wish to have party status, thank you.) ~17'Ie5 J. fin,-su.~,ar~ Printed Name ~~leG ~ (n~ l'_ Address Zip Code Address Signature (Q 7d ) 7 ~'S- o? 3 8 ~ Home Phone # Work Phone # FAX # Date J'c.~yk ~ ~ayy If you are not now a parry and you wish to be named as a party, please provide the following: • How you may be affected or aggrieved by the Board's decision if the Board decides to approve [he application. (Please attach additional pages if needed) • Please explain your opposi[ion to the matter, including a specific description of [he issues [ha[ you feel need to be addressed at [he Formal Board Hearing and why. (Please attach additional pages if needed)