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Mar 21 18 08:37a p.1 <br /> COLORADO RECEIVED <br /> Division of Reclamation, <br /> Mining and Safety <br /> I ..nartmer„of Yat:tral Resources r U v <br /> 1313 Sherman Street, Room 215 DIVISION OF <br /> Denver,CO 80203 MINING&� �T10N <br /> IMAGED DOCUMENTS CD/DNT REQUEST FORM <br /> Imaged documents can be viewed and downloaded free of ebarge in the reception area of the DBMS offices and <br /> online at http://mining.state.cG.us/Reports/Pages/ImagedDocumentData.aspx,or they can be purchased on a CD <br /> or DVD. The CD,/DVD purchase price includes costs for staff time related to data compilation and mailing; <br /> costs. Data on the disk will consist of multiple pdf files and require the use of Adobe Acrobat Reader to be <br /> ti-iewed. <br /> Please indicate the permit and/or file numbers for which you are requesting imaged documents: <br /> 1) A 2&,J!60 9 2) 3) 4) <br /> Please indicate your preference below and return this form with your payment to the Division. If a CD is <br /> requested and the data is too large for a CD,we will contact you. <br /> [gQD @$5.00 per disk(-700IB) 0 DVD @$20.00 per disk(---4.7GB) <br /> Mailing and Contact Information: <br /> Name: vti ez 4t, <br /> r <br /> Company Name: S ��-v► �� �jL- DBMS Use Only: 1 <br /> Mailing CD/DVD created and <br /> Address: �l� rJ' � �.�G� <br /> h--Q tested by: <br /> (Street Address) <br /> (City) (State) (zip) a <br /> Day time Phone Number: <br /> 11111T- <br /> (Date <br /> Signature: <br /> Disclaimer: <br /> T/:e Colorado Dn isirrt ofF,ec ht»rill or.,:Ifnnrg andScrfe!v(DRAISj is not responsible and shalt not he Iiai>le to tke user.for dnnrages of <br /> arr.1•kind ar•tsing out of the use of data or inlor7nation provided hi•DRMS,inchtding,the installation q/'the data informatrnn,its tyre, or <br /> the results•obtained Jrotn its use. .-tn-v data or i,!/ormation proridel by DRHS is "as i.�", whhoul an),rs-urraniy of wn,kind.eitirer <br /> express or tmph"e tncludin;brit not limited to, the implied warranties of rnerclrautobilrty andfitnes.,for a parifei arpu,pose. Doran of <br /> iufor-matron provided nv tire DAMS shall he used and reified upon rusty al the user's sole risk,and thL user agreed to indenui;jy and hold <br /> harrr;less DR4S.it.s oJJieuiLv,u f cenv and employees from crn.v fiabihiv arising T"on:the t,se of tlm dataitrfor»rattotr provided. <br /> /UU`:DCA d:rf art+tio:cm6_r?:)77 <br /> ;�r`C`j�\ <br /> 1313 Sherman Street,Room 215, Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br /> John W.Hickenlooper, Govemor I Mike King,Executive Director Virginia Brannon, Directo <br />