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~~ ~ L} ~ STATE OF COLOR=1~ III IIIIIIIIIIIII III <br />1V~IINED LANI? P.ECLA~~tATION BOARD <br />PARTY STATUS REQUEST FORM 9FCF~V <br />QC r , FD <br />I rzquzst that I nbot be na ned~ p a `ar[ Oih~o~oj~/~fa~&GQ <br />- q - P ~ 9Y <br />x I rzquest to bz withdra« n from parq status <br />In the matter of Ftlz No. A1- 77 _ 196 <br />Hard Rock Pavi <br />& Redi-Mix, Inc <br />Buena Vista Pit <br />For people rho do not titish to become parties in this matter, information on tfte permit <br />application process can be requested from the Disision of t~iinerals and Geolog}. <br />R.E. Steuhenson <br />Printed Namz <br />P.0. Box 1358 <br />Address <br />Buena Vista, Colorado 81211 <br />City, State Zip Code <br />E-Mail Address <br />~Signat <br />(7r~1 ~ 3yS- ~~90 <br />Home Phone; <br />1~'ork Phone Ir <br />( 1 - <br />FAX € <br />Date <br />If you are requesting to be named as a party, please brieFl~ dzscribz below hole you may bz <br />affected or agerie~'ed by agency action in rhz matter;eferznced above. Include a statement of <br />pour opposition or suppoa in the matter. 1'ou ma} attach a ~ti riven statement to this form instead <br />of filling in the spacz bzlo~r. Include a specific description of thz issuzs that you feel need to be <br />addressed at the final hzarins before thz Mined Land Reclamation Board. <br />