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<br />STATE OF COLORADO ECVIVED <br />NIINED LAND RECLAMATION BOARD <br />Ihm 21 2010 <br />PARTY STATUS WITEiDRAW FORM Division of Reclamation, <br />Mining and SafeW <br />perrnit/Permit Am dment Application. <br />In the matter of File No. M-,o -?rv? t <br />Name of Operator/Applicant and Site: v <br />I request I be withdrawn from party status <br />I request I be withdrawn from Party status and I wish to address the Board at the formal hearing, <br />if held, as a non-party <br />(Please note that if -all objecting parties withdraw priar to the date set for the Hoard's <br />consideration of the applictiou, the application may be approved by the Office and no Board <br />hearing held. Thus, there will not be an s r ted to the application. Also, the Board is of for say person to obligated to consider address issue any Issues raised by <br />issues <br />a party that has withdrawn.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing to the <br />Division and provides a response to those issues in the Division's "Rationale for Recommendation. <br />The "Rationale" is available to any person by contacting the Division. For persons who do not wish to <br />become a party or withdraw as a party in this matter, please contact the Division for information on <br />application status. <br />(Please provide the following information if you have or wish to have party status, thank you.) <br />printed am <br />Address <br />City, State Zip Code <br />Elmai1 AdIress <br />Si re <br />,F" 470% a q1- l5'<( <br />Home one # <br />isz ?' ?Z57/ <br />6921 <br />Work Phone # <br />FAX G <br />t , <br />Date <br />T e2ed 60LZt?ZBOLS `00*d3N9UMXd3 13rd3SH1 dH 6b:0T OTOZ 80 uer