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STATE OF COLORADO b .�>(J <br />MINED LAND RECLAMATION BOARIP/i, "0/ <br />44 a/? ` 9 A"' 0i <br />PARTY STATUS WITHDRAWAL FORM ` f 0c <br />In the matter of File No. M- r f f - , Permit/Permit Amendment Applicat <br />Name of Operator /Applicant and Site: (Ai" (d/ l-A 07 °JAN° <br />Signature <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a person or an entity that has withdrawn as a party.)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 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 />Printt n 2 , /\/ 4 /.k) 4/.4E. <br />( 'I <br />/P) one # (77d7 <br />Addres At, �� f 0 / Work Phone # <br />City, Zip Code FAX # i __. / .39 /l <br />E -Mail Addresses --Sti►r /1 n Date <br />12 <br />