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WECEIV <br />APR 7 's 20 l 1 <br />1`? E® Civr ; . of rceciamation, <br />'C n STATE OF COLORADO ??inii?g a,-,d Safety <br />0 4 2011 MINED LAND RECLAMATION BOARD <br />° Field office <br />puran9 eciamat?on, <br />piv?si° n°{and Safety PARTY STATUS WITHDRAWAL FORM <br />wn 9 <br />In the matter of File No. M-I - )Y5 , Permit/Permit Amendment Application. <br />Name 'ofC Operator/Applicant and Site: WildCa T A j n iad (chv AID Y VI X <br />?r-?LrsV? e9 ? vi ? ?'?? ?P? <br />I hereby withdraw as a parry to this matter. <br />V 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a person or an entity that has withdrawn as a party.)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 parry in this matter, <br />please contact the Division for information on application status. <br />or,, 1 <br />Printed Name <br />Address <br />City, State ` Zip Code <br />arm . con <br />wrs <br />ml?k <br />E-Mail Address h- <br />9`70. <br />Home Phone # <br />Work Phone # <br />FAX # <br />Date <br />Signature <br />G N -61 / <br />12