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STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAWAL FORM <br />In the matter of File No. M- ;26 0 ? - o i- . Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site <br />U <br /> <br />_ I hereby withdraw as a party to this matter. <br />I hereby withdraw as a party to this matter and. if the Board holds a hearing. I <br />wish to address the Board at the formal 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 <br />consideration of the application. the application may be approved by the Office without the <br />Board holding a hearing. In that event, there will be no opportunity to address the Board on any <br />issues related to the application. Also. the Board is not obligated to consider any issues raised by <br />a person or an entity that has withdrawn as a party.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing <br />to the Division and provides a response to those issues within its jurisdiction in the Divisions <br />"Rationale for Recommendation." The Rationale is available to any person by contacting the <br />Division. For persons who do not wish to become a party or withdraw as a party in this matter, <br />please contact the Division for information on application status. <br />R(1mt??d2AGA7lCAI ? V <br />Printed Name <br />,z k 4- <br />Address <br />C, 4EL[_t? <br />City. State, e Zip Code <br />E-M 'I Address <br />Signature <br />-Uk' 7 <br />Home Phone # <br />S A rr? c <br />Work Phone # <br />FAX # <br />C!? Q,z JS' <br />Date <br />12