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STATE OF COLORAD ~ III I II I II I II IIII III <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS REQUEST FORM RECEIVED <br />Dui ~;~ 1999 <br />I request th~it I be named as a party <br />Division of Minerals 8 Geology <br />I request thou I not be named as a party <br />I request to be withdrawn from party status <br />In the matter of File No. M-8/ - os a <br />~-r~ih5 ()a„-It!~. ~!-a,..~, Cm-p~ I'~w.cd *'' M- s~- osd- <br />For people who do not wish to become parties in this matter, information on the permit <br />application process can be requested from the Division of Minerals and Geology. <br />.~2raia M./:~....e..l, <br />Printed Name <br />P~o- 4.,,rtZa~ <br />Address <br />sons Coo ;~sy~ <br />Ci:~, State Zip Code <br />1Grry_ Igo we(l ~o u2S CefP•c.o.,., <br />E-Mail Address <br />h, /.~~ <br />Signatu <br />Home Phone # <br />(303)}ya - z69s <br />Work Phone # <br />F?J~ # <br />a-/u/ ~ <br />Dat~ <br />If you are requesting to b~e named as a party, please briefly describe below how you may be <br />affected or aggrieved by agency action in the matter referenced above. Include a statement of <br />your opposition or support in the matter. You may attach a written statement to this form instead <br />of filling in the space below. Include a specific description of the issues that you feel need to be <br />addressed at the final hearing before the Mined Land Reclamation Board. <br /> <br />