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r <br /> A7COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> 1313 Sherman Street. Roam 215 <br /> Denver,CO 80203 <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/PagesllmagedDocumentData.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 /> viewed. <br /> Please indicate the permit and/or file numbers for which you are requesting imaged documents: <br /> 1) M Zai(p Ol D 2) M ZO 17 U 41 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: Se r) ' oA) us r (i e n 1)e rS&+t m <br /> Name: �ii � 1 .t s i l�r' > <br /> Company Name: o tC t i'V} , - r S ✓r r?rDRMS Use Only <br /> Mailing 5 3 -f161 o►' CD/DVD created and <br /> Address: ya-OQ2,1—vr tested by: _ <br /> (Strut Ad" [405 4 I <br /> QNnk�i� — <br /> L2, � lid <br /> (City) (State) (Zip) V77//vc) <br /> Daytime Phone Number: •--7Z � <br /> a <br /> Signature: <br /> Disclaimer: <br /> Ac Colomdv Division of Reclanrarrorr,.l(Wring and S'r feel'lDRti 65 is not responsible and shall trot be liable to the user far damages of <br /> arm kind arising rnrt r f the use oj`data nr-infarmatiort lnocialcd bl'DR1/5, urrluding fire uastallatrotr of dtc darn irrfonnation.its rise, or <br /> the►•exults obtninerl fewer its ucc .bm rlatrr or uilcrrntauwr pm,�iled h1'DR115'is 'as ix",s tdraut anti•surnnrrr r+J urm kiruf,ei�her- <br /> ra�rress w inrplicd,intlrrdutgbrrl uo1 hnrNed to 11rc'uuplied xurmrrties rfnu'rc'harrlabrlrtt and fitnessTrrn prfrticnlur ptn7rnre. Dame), <br /> nrJormatinn pnn'ideti bT the lDR4E slrall he rtscd rrrtrl niterl upon on1v at the riser's sole nsk,arul rite user agues to indemrt yi,and hold <br /> harudesx DR.IIS,its nljicials,officers and emplm-cesfr•onr am'habiliry atimig from the rise rf'tire daralir jzrnrntiwr provided. <br /> 1313 Sherman Street,Room 215,Denver,CO 9=3 P 303.866.3587 F 303.832.8106 http://mining-state.co.us <br /> John W.Hickentooper,Governor I Nuke King,Executive Director I Virginia Brannon,Director <br />