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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- " b 0g - 6.90 , Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: J o rJ Q AJ y )//FAr_E (A0C-,S LL 0' <br />I n LL, k A/ 1= V VF- J-V - e l? Elf- P A Z <br />I r 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-forma4-hearing; i#=held,-as-a-non-patty. -- <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a person or an entity that has withdrawn as a party.)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 />20 N SAKC/2 (9X) k ? 7 <br />Printed Name Home Phone # <br />Ake ( Ah Sl ( ) Sim <br />Address Work Phone # <br />City; State . k- - -_- <br />-_Zc ipa-C?ode FA.X©-# <br />& "127 -- - <br />E-Mail ddress Date <br />Signature <br />12