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. " STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />J PARTY STATUS WITHDRAW FORM <br />In the matter of File . . M-~- ~ S , Permit/Permit Amendment Application. <br />Name of Operator/A tcan ' e: ~77e ~ .°f°-,~}, l~er~., ~, . ~on-~J ~P-,a~ <br />I request I be withdrawn from party status <br />I request I be withdrawn from party status and I wish to address .ite Board at the formal hearing, if <br />held, as a non-party <br />(Please note that if all abjecting parties withdraw rior to the dote set for the Board's consideration of the <br />application, the application may be approved by the Office and no Board hearing held. Thus, there will not be <br />an opportunity for any person to address the Board on any issues related to the application. Also, the Board is <br />not obligated to consider any issues raised by a party that has withdrawn.)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 />~p pVi~G'1 <br />(Please provide the following information if you have or wish to have party status, thank you.) <br />Printed Name Home Phone # <br />Po.~. /~S t9~o) ~7~ -~f~a9 <br />Address Work Phone # <br />8I (~ y r~ <br />City, State <br />Zip Code <br />u>~l~e2m~hL u.. ~~~ a h ~,~ ~ ~on-t <br />E-Mail ddress <br />0170 > ~7t~ -- ~S~fS <br />FAX # <br />9-~a - o a , <br />Date <br />Signature <br />