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970 - 350 -9805 <br />15:48:59 04 -22 -2015 2r2 <br />STATE OF <br />COLORADO <br />DIVISION OF RECLAMATION, MINING <br />AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />COLORADO <br />Phone: (303) $66-3557 <br />Document Imaging CD/DVD <br />D 1 V I s I ON O F <br />RECLAMATION <br />FAX: (303)$32 -8106 <br />REQUEST FORM <br />i MINING <br />SSAFETY <br />Request for the DRMS document images on the following DRMS Permit file(s): <br />1) J\A 1977439 2) <br />M2001051 <br />3) <br />4) <br />The DBMS document images can be copied to either a CD or a DVD. 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 Q $5.00 per disk F-1 DVD @ $20.00 per disk <br />7 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.nuning.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 />Basic Instructions: <br />1. Insert CDlDVD into your disk drive <br />1 Click Yes to Accept the License Agreement for Laserfiche Plus Viewer <br />4. Laserfiche will Load, Opening the Start Page <br />5. Click on the Available Repository and Click Open, You are now ready to view the file(s). <br />DRMS 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 foi <br />damages of any kind arising out of the use of data or information provided by the DRMS, including the installation of the data of <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 kind, either express or implied, including, but not limited to, the implied warranties of merchantability <br />and fitness for a particular purpose. Data or information provided by the DRMS shall be used and relied upon only at the user's <br />sole risk, and the user agrees to indemnify and hold harmless the DRMS, its officials, officers and employees from any liability <br />arising out of the use of the data/information provided. <br />Customer Mailing and Contact Information: <br />.Print dame: LOry Stephens <br />Company: City of Greeley <br />Address: 1100 10th Street <br />Suite 300 <br />Phone: 970 - 350 -9812 <br />Signature: <br />Office of <br />Mined Land Reclamation Denver • Grand }unction • Durango <br />DRMS use only <br />CD/DVD created and <br />tested by: <br />Date: JJ-A& o-�D/ <br />Office of <br />Active and inactive Mines <br />