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STATE OF COLORADO <br />RECEIVED <br />MAY 2 ?�r8 <br />IAUON OFRECt., <br />MININGME) SAFEfy� <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAWAL FORM <br />In the matter of File No, ]W- ZCGq - a t7 1I11Perini0ennit Amendment Application. <br />Name of Opera tor..'Applicant and Site: �loK� f t r rc'+J� t ��s`L [—C _ <br />r <br />V 1 hereby withdraw as a <br />party to this matter. <br />I hereby withdraw as a part), to this matter and, if the Board holds a liearim,. I <br />m <br />N% ish to address the Board at the fora! 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a person or an entity that has withdrawn as a Darty.) <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." Tile 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 inatter. <br />Please contact the Division for information on application status, <br />(is 11-1 -C L -Y�c�. L—L—C- <br />Printed Name <br />R <br />Address <br />�rsc� co g0 ('4L -1 - <br />City, State it <br />Zip Code <br />`t0S tk t� C taco <br />it Addr-ss <br />Signature <br />12 <br />]-ionic Phone m <br />L 1 <br />Work Phone #,` <br />t7- f l L l <br />FAX m .� <br />Date <br />