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JUL-23-2009 02:07PM fjM IV RECLAMATION MINING & SAFETY <br />PSG o???`s {e"? <br /> <br />+3038328106 T-831 P. 002/002 F-854 <br />REMNED <br /> <br />JUL 2 <br />STATE OF COLORADO ? 2009 <br />MrNED LAND RECLAMATION BOARD Mining at 7atioa, <br />Mining annd d Safety <br />PARTY STATUS WITHDRAWAL FORM <br />2cb? ©23 <br />in the matter of File No. M- , Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: Sir,4a )5 K A. 'D M XS,a Fl.-E?- _ <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a person or an entity that has withdrawn as a party.)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 parry 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 />( 973 S4?! 1153 <br />Printed Name Home Phone # <br />As -,d W ? <br />Address Work Phone # <br />city ?tAt. Zi-D Code FAX # <br />Date <br />12