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NFU-14-2000 18 23 FROM 970)927-8386 GRRNT TO 13038328106 P.01 <br />~ 1'A 1 ~ OF COLORADO <br />M~ED LAND RECLAMATION BOARD <br />PARTY STATUS REQUEST FORM <br />In the matter of File No. M-~_((~~ PermitlPermit Amendment Application. <br />Name of Operator/Applicant and Site: <br />I request that I be named as a party <br />I request that I not be named as a party <br />_ I request to be withdrawn from party status <br />1 understand that if I am not a party, my statements oCconcern 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 hecome parties in this matter, information on permit <br />application status can be requested from the Division of Minerals and (Geology. <br />I~ted aJeS ~.C9ra.,,~ <br />36 ~ x /6R7 ~ /~a uJ b..eS~ sr <br />ddress <br />Ali. ~~- G . ~/6 as <br />Ctty, State Zip Code <br />E-Mail Address <br />~J <br />Signat <br />9~0~ 9a~_3-zol <br />Home Phone!! <br />{,9~1 ~aS- 9/~ <br />Work Phone # <br />~97u1't~- ~d 7 ' ~'3 Fri <br />FAX # <br />1L~aJ. /~ aooo <br />Date <br />ICyou are requesting to be named as a party, please briefly describe below: <br />1. how you maybe affected or ag;rieved by the Board's decision in the matter referenced above, <br />2. your oppositson 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 />j~(~s e <br />~~ .w <br />St'.-~ s,~rr^a.T~eK on '~-~s ~~~1l~~bti acs you <br />p~pti,(~(` <br />1v0o~rn F ~~• %'~ <br />~ ~ ~-- <br />