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COLORADO <br /> Division of Reclamation, RECEIVED <br /> jMining and Safety <br /> Department of Natural Resources <br /> MAY 2 2 Z018 <br /> 1313 Sherman Street, Room 215 �IVISIGN <br /> Denver,CO 80203 OF RECL q�gTlpN <br /> MINING ANp SAFE y <br /> IMAGED DOCUMENTS CD/DVD REQUEST FORM <br /> Imaged documents can be viewed and downloaded free of charge in the reception area of the DRMS offices and <br /> online at http://mining.state.co.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 tiles and require the use of Adobe Acrobat Reader to be <br /> viewed. <br /> Please indicate the permit and/or file numbers for which you are requesting imaged documents: <br /> I) M-1984-094 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 /> CD @$5.00 per disk(-700MB) DVD @ $20.00 per disk(-4.7GB) <br /> Mailing and Contact Information: <br /> Name: George M.L. Robinson <br /> Company Name: R Squared, Inc. DRMS Use Only: <br /> Mailing CD/DVD created and <br /> Address: 3926 North State Hwy 67 tested by: <br /> (Street Address) <br /> Sedalia Colorado 80135 <br /> (City) (State) (Zip) ame) <br /> Daytime Phone u er: 303.832.7664 / <br /> .5 <br /> Date <br /> Signature: <br /> Disclaimer: <br /> The Colorado Division of Reclamation, Alining and Safer)?(DRAIS)is not responsible and shall not be liable to the user for damages of <br /> any kind arising out of the rise of data or information provided by DRAIS, including the installation of the dater information.its use, or <br /> the results obtained fr•orn its use. Any dater or information provided by DRMS is "as is",without any ivarranty of any kind,either <br /> express or impliedd, including but not limited to,the implied warranties of merchantabilit),and fitness for a particular purpose. Data or <br /> information provided by the DRMS shall be used and relied upon only at the user's sole risk,and the user agrees to indemnif.v and hold <br /> harmless DRMS.its officials,officers and employees from any liability arising from the use of the data information provided. <br /> /DD V DDrderForm8November2017 <br /> Or Cp <br /> aw � <br /> o <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, Governor I Mike King, Executive Director I Virginia Brannon, Director <br />