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1~ED LAND RECLAOMATIONO~ARD III IIIIIIiII'III'll <br />PARTY STATUS REQUEST FORM y~G~1VEp <br />In the matter of File No. M- 79 - 158 , PermitlPermit Amendment Applicatiot~n~t. ~2 ~~~ <br />Name of Operator/Applicant and Site: Colorado City Metropolitan Distri~~ <br />Mountain Shadows Pit •,"..,,~ot t <br />I request that I be named as a party <br />I request that I not be named as a party <br />XX I request to be withdrawn from party status <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 />__John T. Randerson {719) 489-3604 <br />Printed Name Home Phone # <br />10550 Dod~,e Road { ) _ <br />Address Work Phone # <br />_Rye, CO 81069 ( 1 - <br />City, State Zip Code FAX # <br />-Mail Address <br />5/18/00 <br />!' / -~~' <br />nature 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 />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 />