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RECEIVED <br /> MAR 2 5 2019 <br /> MVON OF REq AWT01 <br /> STATE OF COLORADO M1N1NGAMD&kcETy <br /> MINED LAND RECLAMATION BOARD <br /> PARTY STATUS WITHDRAWAL FORM <br /> In the matter of File No. M- D I�- Q ' / , Permit/Permit Amendment Application. <br /> Name of Operator/Applicant and Site: 17 V j o IJ,41 d, <br /> 1 z44 <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 a person or an entity that has withdrawn as a party.)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 /> Th i 1 I i 'D RC L b n .- <br /> Printed Name Home Phone# <br /> A ess //`` �i,, Work Phone# <br /> Cit , State . Zip Code FAX# <br /> � -�9- �� � <br /> E it Date <br /> UA/ ft)�a4� <br /> Signature <br /> 12 <br />