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Jl:i7~. yr ~.VI~Vt~i1/V <br />III IIIIIIIIIIIII III iVII.NED LAND RECLAMATION BARD Received <br />PARTY STATUS REQUEST FORM '~~~ 1 0 2000 <br />In the matter of File No. M ~ °yq , permit/Permit Amendment Applicati~rv~pn o~~gqeield pryice <br />Name of Operator/Applicant and Site: Lpcl.tS I aita Lan acrd G~ctvel, ~~Geoiogy <br />I request that I be named as a party <br />I request that I not be named as a party <br />I request to be withdrawn from party status <br />~~~y~~ <br />®~~ <br />~(~@Lp~ ~~~ ~~~ <br />~f ~ . ~ ~', <br />~1~-L. M`ZDpD o~Y <br />~ %o^ <br />~~a/~ ~ <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 one, ermjl`~if~ <br />application status can be requested from the Division of Minerals ant} eolo~o j <br />RoIiERy' W~ BRAS era 3~~ ~s~o„o~~~, ~~~~~ <br />Printed Name - - Home Phone #. ~ <br />~ ~ x ~ S- f 1 <br />Address //1~, Work Phone # <br />City, State _ _ Zip Code FAX # <br />E-Mail Address <br />Signature Date <br />Ii 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 />