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e s c~ cb,tit <br /> <br />/APR~07 2006 STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />/pry~too of xuaaava tteabel <br /> <br />PARTY STATUS WITHDRAWAL FORM <br />In the matter of File No. M-o~~o 003 , PermitlPermit Amendment Application. <br />Name of Operator/Applicant and Site:~~ b er~_1 _~.,(_~.,( <br />NQ..~ 1~2 c„n~f <br />_~ I hereby withdraw as a party to this matter. <br />I hereby withdraw as a party to this matter and, if the Boazd holds a hearing, I wish to address <br />the Boazd at the fonnal 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 consideration of <br />the application, the application may be approved by the Office without the Board holding a hearing. <br />In that event, there will be no opportunity to address the Board on any issues related to the <br />application. Also, the Board is not obligated to consider any issues raised by a person or an entity that <br />has withdrawn as a party.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing to the <br />Division and provides a response to those issues within its jurisdiction in the Division's "Rationale for <br />Recommendation." The Rationale is available to any person by contacting the Division. For persons who do <br />not wish to become a party or withdraw as a party in this matter, please contact the Division for information <br />on application status. <br />P.(' i <br />Printed ame <br />199~~ro?~Ly(2a¢~J..i e d~.~AZL <br />Address 1( <br />CZe,n~e,r~ Gd gaan a, <br />City, State Zip Code <br />T2nr;ah~r ~ ~1MG.t~rv~ <br />E-Mail dress w n n . <br />~ - <br />Home Phone # <br />(Z2o ~ any -aco~12 <br />Work Phone # <br />r3n~ ~ ~g t~ - 3 t~ c~ ii <br />~i~`51o~ <br />Date <br />Signature <br />