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cV <br />+ , cr <br />OCR 7 2009 <br />eta d Safefij n, <br />Mining <br /> <br />NOV 2 5 2,009 <br />STATE OF COLORADO GRAND 1%1A 1-?ELD OFFICE <br />10 . i;ON OF <br />MINED LAND RECLAMATION BOAIDL.Ak4A711" ?;?rNING & SAFETY <br />PARTY STATUS WITHDRAWAL FORM <br />In the matter of File No. M-1 Rg - 0o-)a , Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: r! ?A (P coo S ???? one <br />I hereby withdraw as a party to this matter. <br />I hereby withdraw as a party to this matter and, if the Board holds a hearing, I <br />wish to address the Board at the formal hearing, if held, as a non-party. <br />(Please note that if all objecting parties withdraw prior to the date set for the Board's <br />consideration of the application, the application may be approved by the Office without the <br />Board holding a hearing. In that event, there will be no opportunity to address the Board on any <br />issues related to the application. Also, the Board is not obligated to consider any issues raised by <br />a person or an entity that has withdrawn as a party.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing <br />to the Division and provides a response to those issues within its jurisdiction in the Division's <br />"Rationale for Recommendation." The Rationale is available to any person by contacting the <br />Division. For persons who do not wish to become a party or withdraw as a party in this matter, <br />please contact the Division for information on application status. <br />if?), ; Y•l ee13oweys 1?-lP Ciss? C?o?..lerS <br />Printed Name <br />4335 Cnorb-P& <br />Address LC) ¢ <br />City, State Zip Code <br />E-Mail 2ddre s <br />Signature <br />Home Phone # <br />( L s ayVQz <br />Work. Phone # <br />1 <br />FAX # <br />11121 Date <br />