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RECEIVED N~ED LAND RECLAA? TION B+-RD III IIII IIIIIIIII III <br />999 <br />• ' MAYO 1 ~~ PARTY STATUS REQUEST FORM <br />ptvision of Minet~s & Geob9Y <br />In the matter of File No. M-~- ~Q~.Permit/Permit A.•ttendment Application. <br />Name of Operator/Applicant and Site: ~CTti ~it?~ ~ So S - c <br />1 n 11 <br />C]~a ~~~1'S- ~R~~ t)UQetG ~ snDitP~ i~2D , j <br />I request that I be named as a party <br />I request that I not be named as a party <br />~ I request to be withdrawn from party status 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 oC 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 />Jaws <br />Printed Name <br />ysn Ca,~.m~oAD t ~ <br />P.~Se Cu 8 t..Z~{ a <br />City, State Zip Code <br />E-Mail Address <br />~' ~iia•-~ ~ fc <br />i ature <br />~~ <br />Home Phone # <br />t ~ - ~wr e _ <br />Work Phone # N /~ <br />( 1 <br />FAX # <br />y 26 ~~ <br />Date <br />If you are requesting to be named as a party, please briefly describe below: <br />1. how you maybe affected or aggrieved by the Boazd'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 />