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AIMCW COLORADO RECEIVED <br /> RECEIVED <br /> Division of Reclamation, <br /> A&V Mining and Safety APR 13 2020 <br /> Department of Natural Resources <br /> APR ; <br /> 1313 Sherman Street, Room 215 DIVISION OF RE(� DIVISION OF RECL"T1Q,4 <br /> Denver, CO 80203 11Iyl�GAl'� MININGAND SAFM <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 files and require the use of Adobe Acrobat Reader to be <br /> viewed. <br /> Please indicate the permit and/or file numbers for which au are requesting imaged documents: She e �k r jt�5 <br /> ci <br /> 1) 2) 3) 45 <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 cr $20.00 per disk(---4.7GB) <br /> Mailing and Contact Information: V <br /> Name: �Te( <br /> Company Name: ri DRMS Use Only: <br /> Mailing CD/DVD created and <br /> Address: 6503 tested by: <br /> (Street Address) <br /> � I9 <br /> (City) (State) (zip) (Name) <br /> Daytime Phone Number: _ o 3 S.) — S n <br /> ate <br /> Signature: <br /> Disclaimer: <br /> The Colorado Division of Reclamation,Mitturg and Safety(DRMS)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 DRMS, mchiding the installation of the data it formation, its rise, or <br /> the results obtained from its rise, Anv data or information provided by DRMS is "as is", withord any warranty of ant kind,either <br /> express or implied,inchiding brit not limited to, the implied warranties of merchantability rind fitness.for a particular purpose. Data or <br /> information provided by the DRMS shall be used and relied upon onl v at the user's sole risk,and the user agrees to indemnifv and hold <br /> harmless DRMS, its oflicials, officers and emplorees f•our arty habrlav arisnig front the rise of the dcttalitrformarion provided. <br /> DD VDOrderForm8 Nocember201 <br /> pf 179to-P <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 />