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r STATE OF COLORAD~ R~@1V~ <br />i~I1~IED LAND RECLA1bIATI01~i BOARD MAR2 0 <br />?ppl <br />PARTY STATUS FORtvI O~ <br />In the matter of File No. IvI- t ~t - Go' , Pet-mitlPermit Amendment Application. Brats & Ge p%y <br />Name of Operator/Applicant and Site: _Fou~ S~a~1'es Q ti A ~e~a'(-ea , L L G , <br />L.~[..e CRmp P'.}~ <br />f 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I request I be withdrawn from party status 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 />hearing, if held, as a non-party <br />(Please note that if all objecting parties withdraw rto 'or 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. If 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has withdrawn.)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 information if you have or wish to have party status, thank you.) <br />SuSa., Loma?.o <br />Printed Name <br />26 6$5 }}~c,1,w~.~ I4 S' <br />Address <br />~o~~-e~ ro ~13z3 <br />City, State Zip Code <br />Slocal,o ~ ~+~~wes~-.COm <br />E-Mail Address ~ r <br />wl rv. .~(~` r <br />Signature <br />~) Fis2-otlo <br />Home Phone # <br />Work Phone # <br />O <br />FAX # <br />!I [.yL(~~ 1~ ZO U <br />Date <br />If you are not 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 />/LLO c~t'1'u 11.a.G <br />(Please attach additional pages if needed) <br />Please explain your opposition to the matter, including a specific des~n[~ion of the issues that you feel need to be <br />addressed at the Formal Board Hearing and why. ate a~d-ed __ <br />(Please attach additional pages if needed) <br />