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III IIIIIIIIIIIII III • STATE OF COLORAD~ ~EC~/VET MINED LAND RECLAMATION BOARD Fig p ~ 7001 PARTY STATUS FORM ~~~isionallyineralsand CeologY In the matter of File No. M- aooo _ lSd , perrnit/Permit Amendment Application. "'~ Name of Operator/Applicant and Site: P1q{}Q, Sand r ro~e~ l.t_C we, u _ I request that I be named az a party _ I request thzt I not be named az a patty 2C I understand that I have party status _ I request I be withdrawn from party status _ I wish to address the Board at the formal hearing, if held, az anon-party (Please note that if all objecting parties withdraw nD 'Or t0 the date set for the Division's recommendation for approval or denial, there may not be an opportunity for any person to address the Board on any issues related to the application. If all objecting parties withdraw their objection after the above referenced date, the Board may still hold a formal hearing, however the Board is not obligated to consider any issues raised by a party that has withdrawn.) Regardless of a party stams, the Division thoughtfully considers each issue submitted in writing to the Divisior. and provides a response to those issues in the Division's "Rationale For Recommendation ". 'I7te "Rationale" is available [o any person by contacting the Division. For persons who do not wish to become a party or withdraw as a party in this matter, please contact the Division for information on application status. (Please provide the following information if you have or wish to have party status, thank you.) rl~chae~ ~ .P+R~r„{~ (~03) -t ga-oyev Printed Name Home Phone N ~Sli SoutL. Viha Sfi -3( °3 ~ s4S-at,oo Address Work Phone 8 ~`^glew•oc~ GU 801[0 ( 303) lot-a~`l'~ t City, State Zip Code FAX q E•Mail Address ~ Date Signature If you are not now a patty and you wish to be named as a party, please provide the following: • How you may be affected or aggrieved by the Board's decision if the Board decides to approve the application. (Please attach additional pages if needed) please explain your opposition to the mater, including a specific description of the issues that ycu feel need to be addressed at the Formal Board Hearing and why. (Please attach additional pages if needed)