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STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAWAL FORM <br />hi the matter of File No. M-~Z- Qd~ , Permit/Pennit Amendment Application. <br />Name ofOperator/Applicant and Site: flQ~t~ ~ ~ - c ~C <br />KiorJ~ rla,.~ ll''tin~_ -5¢,c,ilton /9 ou3nSh~~' <br />I hereby withdraw as a party to this matter. <br />I hereby withdraw as a party to this matter and, if the Board holds a hearing, I <br />wish to address the Board at the formal hearing, if held, as a non-party. <br />(Please note that if all objecting parties withdraw prior to the date set for the Board's <br />consideration of the application, the application may be approved by the Office without the <br />Board holding a hearing. In that event, there will be no opportunity to address the Board on any <br />issues related to the application. Also, the Boazd is not obligated to consider any issues raised by <br />a person or an entity that has withdrawn as a party.) <br />Regazdless of a party status, the Division thoughtfully considers each issue submitted in writing <br />to the Division and provides a response to those issues within its jurisdiction in the Division's <br />"Rationale for Recommendation." The Rationale is available to any person by contacting the <br />Division. For persons who do not wish to become a party or withdraw as a party in this matter, <br />please contact the Division for information on application status. <br />keel rh J ~ ~'P~c"e~` <br />Printed Name <br />Ad ess <br />he~f ~~ds~e_ ~- <br />City, State ~ ode <br />C~ ~~~~ <br />E-Mail Addre s <br />~,, rrn, t~ ~,~ ~~~ <br />(~03, y2o-o~63 <br />Home Phone # <br />Work Phone # <br />FAX # ~.. /c <br />Date <br />Signature <br />12 <br />