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.: <br />7~ <br />r~~ <br />STATE OF COLORADO <br />N~INED LAND RECLAMATION BOARD <br />l//P TATUS WITHDRAW FORM <br />In the matter of ile No. -,~,~- ~ S , Perm;t/Permit Amendment <br />Name of Operator/Applican an ite: 'fin ~- o,~x~ ~,e. , 9, ~oz~-d~ .C <br />I request I be withdrawn from party status <br />Application. <br />I request I be withdrawn from party status and I wish to address ;he Board at the formal hezrir. ~, if <br />held, as a non-party <br />(1?iea.~e note *_hat if al' objecting parties withdraw. riF or 10 the date stt far the Boa:d's consideration. of the <br />application, the application may be 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not obligated to consider any issues raised by a party that has withdrawn.)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 />p,u C~ ' <br />(Please provide the following information if you have or wish to have party status, thank you.) <br />Printed Name <br />~o ~ /~ S, <br />Address /~ ~~ <br />City, State <br />Zip Code <br />Home Phone # <br />Work Phone # <br />FAX # <br />Date <br />RECEIVED <br />SfP 12 2002 <br />~ivtsten of Minerals and Geofog~ <br />