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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- ;20 D F - b P () , Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: <br />-S'o 11 12 ,r V I/ i= Al ?zi, <br />L <br />_I,-,' 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-hear-ing,-i-f-held; as-a-non-par-ty. - -- - - - - <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a person or an entity that has withdrawn as a party.)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 />R (i M 13 40,Pt e-A 77a.nl o ( 97-6 ) ,S.5' --)- - 6 9- 7 2 <br />Printed Name Home Phone # <br />Address I Work Phone # <br />C, 4 eELEV P0621 ( ) <br />____City,_S.tat Zip Code FAX_#_. <br />?q/ ,4 o y?n _??? u v y <br />E-M '1 Address J Date <br />7//x'1 st?"? - ?,c? c's? h <br />Signature <br />12