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STATE OF COLORADO <br />nIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />DF•nver, Colorado 80203 COLOR ADO <br />r D I V I s I O N O F <br />Phone: (303) 866 -3567 Document Imaging CD/DVD J� RECLAMATION <br />FAX: (303) 832-8106 t MINING <br />REQUEST FORM 1 (�S —&— <br />0 6 �'` SAFETY <br />Request for the DRMS document images on the flowing D�R- /MS Pe 't file(s): 15 <br />1)071- -IP 2) A —G'la 9 I "' 0b -��l 4) �0I <br />The DRMS document images can be copied to either a CD or a D. Please check one below and return <br />this form with your payment to DRMS. If a CD is requested and the permit is too large for a CD, you will be called. <br />CD @ $5.00 per disk 9 DVD @ $20.00 per disk <br />Please check if you want a copy of the Directions for Use of CD/DVD <br />The Permit File document images can be viewed in the reception area of the DRMS office, online at www.rmning.state.co.us, or <br />they can be purchased on a CD or DVD. The CD/DVD purchase cost covers the time and labor of making the CD/DVD. <br />2. Click 14— t- 4cC2+1L1hz-LiQ411-- . rgle- - . <br />4. <br />5. CLak-c��lableJ?-epasd=y-and <br />DBMS cannot provide computer related support. <br />Disclaimer: <br />The Colorado Division of Reclamation, Mining and Safety (DRMS) is not responsible and shall not be liable to the user fc <br />damages of any kind arising out of the use of data or information provided by the DRMS, including the installation of the data c <br />information, its use, or the results obtained from its use. Any data or information provided by the DRSM is provided "as is <br />without warranty of any hind, either express or implied, including, but not limited to, the implied warranties of merchantabilit <br />and fitness for a particular purpose. Data or information provided by the DRMS shall be used and relied upon only at the user' <br />sole risk, and the user agrees to indemnify and hold harmless the DRMS, its officials, officers and employees from any liabilit <br />arising out of the use of the data/information provided. <br />Customer Mailing and Contact Information: <br />Print Name: P" EM ad (-(,I rt S <br />Company: <br />Address: 0 0t <br />-T- DaGw S "ham, <br />Phone: 303 —5--70 <br />Signature: - -� <br />Office of <br />Mined Land Reclamation Denver • Grand junction • Durango <br />DRMS use only <br />CD/DVD created and <br />tested by: <br />Date: / <br />Office of <br />Active and Inactive Mines <br />