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STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAWAL FORM <br />In the matter of File No. M46 QS' - O S'Q . Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: Z _op ce Q nlV11E Al-llt A9C J L G 0 <br />-.T;J it P AJ 0 LV 11p, i 7-/i j213'( i <br />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a person or an entity that has withdrawn as a party.)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 Division's <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 />h n N RAKE/<' <br />Printed Name <br />.;?, kY"J L. N Tel I n s l <br />Address <br />6Q '1=Lt=a L <br />City. State Zip Code <br />E-Mail,Address <br />( 2,x)) 3 .2 - 6 8 2 7 <br />Home Phone # <br />( ) S,4/7a F -- <br />Work Work Phone # <br />FAX # / <br />e V o /ova Sr <br />Date <br />Signature <br />12