Laserfiche WebLink
<br />STATE OF COLORADO RECEIVED <br />MINED LAND RECLAMATION BOARD DEC 122005 <br />PARTY STATUS WITHDRAW FORM nirisionutbtinenla+nrc~iM- <br />In the matter of File No. Mz~ - O ~~ , Permit/Permit Amendment <br />Name of Operator/Applicant and Site: C/P ~.n~reet< 9~Stric+ W~, (-e~ ; <br />I request I be withdrawn from parry status <br />I request I be withdrawn from parry status and I wish to address the Bord at the formal heazing, if <br />held, asanon-party <br />(Please note that if all objecting parties withdraw rior to the date set for the Board's consideration of the <br />application, the application maybe approved by the Office and no Board hearing held. Thus, there will not be <br />an opportunity for any person to address the Board on any issues related to the application. Also, the Board is <br />not obligated to consider any issues raised by a party that has withdrawn.) <br />Regazdless of a party status, the Division thoughtfully considers each issue submitted in writing to the Division and <br />provides a response to those issues in the Division's "Rationale for Recommendation ". The "Rationale" is available to <br />any person by contacting the Division. For persons who do not wish to become a party or withdraw as a party in this <br />matter, please contact the Division for information on application status. <br />(Please provide the following information if you have or wish to have party status, thank you.) <br />~- r"VlA1G- L. TiJ t~ ~ e G- c3r., ~ L73-~ X79 <br />Printed Name Home Phone # <br />3 ~ 45 y <br />Address <br />~6/dam ~, <br /> <br />C~~~~~ <br />City, State ~7 <br />E-Mail A¢dress <br />Wark Phone # <br />Zip Code FAX #^~ <br />Date <br /> <br />C` n <br />Signature <br />