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Oti/20/00 12:29 F.4S 970 327 4608 R'ESTSTAR BANK ~ 01 <br />~' J1Alr. Vt' I.VLViCALV ;~" <br />III IIIIIIIIIIIII III ~NED LAND RECI;AMATIOIV~~ARD ~~,~~, <br />sss <br />PARTY STATUS REQUEST FORM JUy 2 0 2(lOll <br />I <br />In the matter of File No. M-j o0-_o y9 . Pertttit/Permit Amendment Application. ~ <br />Durango Fietd Office <br />Name of Operator/Applicant and Site: ~ o~ i ~ j.p+•+n Lard xrltj ~-+r ' 'aion of Minerals 8 Geology <br />C~-r~yfyl LLC A„n.c ~'~~r <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_ I request to be withdrawn from party status 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 />lJ ~.~ u a: <br />E"I~~: i/1~2voo_ ~oy9_.. <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 Baard on this matter at the Pnal hearing, and may present my concerns as an <br />interested member of the public. ,p <br />For people who do not wish to become parties in this matter, inforrr~tion erm <br />application status can be requested from the Division of Minerals an~.~q~olo ~.~ <br />n~_ ~ <br />tY\~r 1,e\\e S. m sr 1C~ <br />Printed Name _ . _ . . <br />P. O. C3ox /y5 <br />Address <br />Red~n9e , CD 8 1 x-13 I <br />City, State Zip Code <br />-- Home Phone # <br />E-Mail Address <br />tie ` /me M 1 <br />Signat <br />Work Phone # <br />L ~ <br />FAX # <br />1JatC <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 />2. your opposition to the matter, including a specific description of the issues that you fee] 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 />I ~ eoOnsf!t to ~i.Q Ahgi Pit For '4l~ Fello 'trrv <br />ro nson S - <br />1 fllAiao Du~4, yil~ratore ~rCrr+ Pai i~{h~ r<~ w~l r>ir ~ <br />