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. STATE OF COLORADO <br />~-- M~D LAND RECLAMATION I~RD <br />PARTY STATUS REQUEST FORM <br />In the matter of File No. M-~- ~8 , Pppermit/Permit A^mendment Application. <br />Name of Operator/Applicant and Site: C!t(~n~S - IG_i Jl,fl( Iel,i1 ~Sflc7 t'~G2.~5 <br />I request that I be named as a party <br />I request that I not be named as a party <br />V I request to be withdrawn from party status <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 />aplpl/ication stactus can be requested from the Division of Minerals and Geology. <br />Printed Name 1 Home Phone # <br />Add ss ~ Work Phone # <br />City, Mate Zip Code FAX # <br />~- ~ ~-©o <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 />