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STATE OF COLORAD '~ ` r~ 5 <br />, ~NED LAND RECLAMATION~ARD III IIIIIIIIIIIII III <br />sss <br />' ~ PARTY STATUS REQUEST FORM <br />In the matter of File No. M-gam- p 3 r{ . Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: J,, a s 4nS~ a5 I' o u nTti A~ e P o e T P; T <br />I request that I be named as a party <br />I request that I not be named as a party ~~C~~~E~ <br />I request to be withdrawn from party status DEC 2 0 1999 <br />;;nn of Mineray 8 Geology <br />I understand that if I am not a party, my statements of concern or objection to this <br />application will not be considered during the review of the application, but I may address <br />the Board on this matter at the final hearing, and may present my concerns as an <br />interested member of the public. <br />For people who do not wish to become parties in this matter, information on permit <br />application status can be requested from the Division of Minerals and Geology. <br />FcanK Q, ('anTo~a> <br />Printed Name <br />1747'~l Co,Rd, 87,0 <br />Address <br />?;n; do d., Cnlo• S~oRa <br />City, State Zip Code <br />(71Q 1 8NG- R'4! ~ ~ <br />Home Phone # <br />Work Phone # <br />FAX # <br />E-Mail Address <br />Signature Date <br />If you are requesting to be named as a party, please briefly describe below: <br />1. how you may be affected or aggrieved by the Board's decision in the matter referenced above, <br />2. your opposition to the matter, including a specific description of the issues that you feel need <br />to be addressed at the final hearing. (You may attach a written statement to this form instead <br />of using the space below.) <br />us T. o i s~ i -f Q e r_ l a m a T,- /Ln n F P. T ~J: // ~.~ J.~ <br />lj n1e~5 t,J/~; r.{> ~~~ /l ~. nJIP.~T u~ eTp.s i ~ bre ~1. in e5a~,~`roe5. <br />