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STATE OF COLORADO • <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS FORM <br />In the matter of File No. M- 00 ~ • 0 3 y , Permit/Permit Amendment <br />Name of Operator/Applicant and Site: w ./.• -hp ~ ~ m a b : ~ .¢_ N o <br />vn_ ~4 <br />I request that I be named as a party <br />I request that I not be named as a party <br />I understand that I have party status <br />I request I be withdrawn from party status <br />I wish to address the Board at the formal <br />heazing, if held, as a non-party <br />(Please note that if all objecting parties withdraw rior to the date set for the Division's recommendation for <br />approval or denial, there may not be an opportunity for any person to address the Board on any issues related <br />to the application. V all objecting parties withdraw their objection after the above referenced date, the Board <br />may still hold a formal hearing, however the Board is not obligated to consider any issues raised by a party that <br />has withdrawn.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing to the Division and <br />provides a response to those issues in the Division's "Rationale For Recommendation ". The "Rationale" is available to <br />any person by contacting the Division. For persons who do not wish to become a party or withdraw as a party in this <br />matter, please contact the Division for information on application status. <br />(Please provide the following i4~1formation if you have or wish to have party status, thank you.) <br />rw•c wot.~-ev~e~Q. Glace e.~L ,. <br />1)0~.. v..nvoJ};t.A ~ t'ha.-.aaPe (quo) ~9~-O`Il~ <br />Printed Name Home Phone # <br />Address Work Phone # <br />L.. ts-~-~ l a.., d ~ o o S 3~ <br />City, State Zip Code <br />de~laY €? ~Q,.-~~1:.~I~ . ,,.mot <br />E-Mail Addre~s <br />w~ G~ <br />( 70) ~¢3j- ~J14 <br />FAX # <br />7 ~~ ~o~ <br />' <br />Dale <br />If you are no[ now a party and you wish to be named as a party, please provide the following: <br />• How you may be affected or aggrieved by the Board's decision if the Board decides to approve the application. <br />(Please attach additional pages if needed) <br />Please explain your opposition to the matter, including a specific description of the issues that you feel need to be <br />addressed at the Formal Boazd Hearing and why. <br />III IIIIIIIIIIIII III <br />sss <br />(Please attach additional pages if needed) <br />