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STATE OF COLORADO AL <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> - �1� A, <br /> CO LO FLADO <br /> DIVIS to N OF <br /> Phone:(303)866-3567 Document Imaging C RECLAMATION <br /> DfDVD MINING <br /> FAX:(303)832-5106 & <br /> REQUEST FORM S <br /> SAFETY <br /> Request for the DRMS document images on the following DRMS Permit file($): <br /> 1) M-86-040 2) 3) 4) <br /> The DRMS 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 @$5.00 per disk 0 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.mining.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 /> I Insert CD/DVD into your disk drive 2 Click Yes to Accept the License Agreement for Laserfitche Plus Viewer <br /> 4, Laserfiche will Load,Opening the Start Page ready to view the file(s). <br /> 5. Click on the Available Repository and Click Open, You are now <br /> DRMS cannot sumr—t- <br /> Disclaimer: <br /> The Colorado Division of Reclamation. Mining mid Safety (DRMS) is not responsible and shall not be liable to the user fb: <br /> damages of any kind arising out of the use of data or informati6n 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 merchantabilitN, <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 liability <br /> arising out of the use of the data/information provided. <br /> Customer Mailing and Contact Information. DRMS use Only <br /> Print Name: Alan Goldich CD/IDVD created and <br /> Routt County Planning tested by: <br /> DRMS <br /> - <br /> ""'only <br /> D/D created and <br /> tested <br /> ted by. <br /> Company: — <br /> Address: PO Box 773749 <br /> Steamboat Springs, CO 80487 FDate: <br /> Phone: 970-879-2704 <br /> Signature: _ „ <br /> Office of <br /> Office of Denver Grand junction Durango Active and inactive Mines <br /> Mined Land Reclamation <br />