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<br />STATE OF COLORADO <br />)v~ED LAND RECLAMATION ~ARD <br />PARTY STATUS REQUEST FORM <br />In the matter of File No. M-;,Zoo1- D~Q • Permit/Permit Amendment Application. <br />Name of OperatorlApplicant and Site: ADD ~.Fe ~T C n J c-rRu ~TOns T.~e.. <br />Let ~Io~rc t,~~s-r ~a~.t-ems P,s <br />. .. I1 . .. <br />I request that I be named as a party <br />I request that I not be named as a party (k • Zdp l -o d' <br />I request to be withdrawn from party status ~~' ~d~~ qq <br />1 <br />I understand that if I am not a party, my statements of concern or objection to this <br />application will not be considered during the review of the application, but I may address <br />the Board on this matter at the final hearing, and may present my concerns as an <br />interested member of the public. <br />For people who do not wish to become parties in this matter, information on permit <br />application status can be requested from the Division of Minerals and Geology. <br />~tCl~{nJL(~ F~ 3lAec1 <br />Printed Name <br />.~ ~ s'~ I,J . `1 ~ <br />address <br />L>EL i~t~2r~.. ~o~o ~d113z <br />City, State Zip Code <br />YC6Utc1L~ a(~Ual.oo ~ Cnro <br />('11w1 ~a?- 3a 33 <br />Home Phone # <br />('] ~~) $sz _ asst, <br />Work Phone # <br />FAX # <br />E-Mail Address <br />Signature <br />I D -3 -o I <br />Date <br />If you are requesting to be named as a party, please briefly describe below: <br />1. how you maybe affected or aggrieved by the Board's decision in the matter referenced above, <br />2. your opposition to the matter, including a specific description of the issues that you feel need <br />to be addressed at the final hearing. (You may attach a written statement to this form instead <br />of using the space below.) <br />~$ <br />pMB~~~ Field Office <br />of Minerals $ Geolo9Y. <br />