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COLORADO <br />Division of Reclamation, ��,V��ss'� <br />Mining and Safety E <br />Department of Natural Resources � 201313 Sherman Street, Rop SEP <br />Denver, CO 80203 <br />jD(q&at3 OF RECL"110" <br />MIt,l rl,GAMSWEN <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 you are requesting imaged documents: <br />1) M-1996-060 <br />2) M-2017-036 3) M-2004-051 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 />7 CD @ $5.00 per disk (-700MB) <br />Mailing and Contact Information: <br />Name: William Schenderlein <br />Company Name: Blue Earth Solutions <br />FX DVD @ $20.00 per disk (-4.7GB) <br />Mailing <br />Address: P.O. Box 2427 <br />(Street Address) <br />Fort Collins CO 80522 <br />(City) (State) (Zip) <br />Daytime Phone Number: (970) 227-2803 <br />Signature: <br />Disclaimer,- <br />DRMS Use Only: <br />CD/DVD created and <br />tested by: 1� <br />) <br />Eli <br />The Colorado Division of Reclamation. i lhriirg arul5crletr (DR.114! is not responsible tind shall not he liable ro the user 101' damages of <br />tier kind crri.sing ota of rhe use ofdara or inlorniation proruled hs DR -AN. mclrrdirrg the rfrsfrrllrrriarr ofllrr c1tticr it f)r•rmation, ifs use. or <br />the results ohie ined fi•unr ifs use- .4q -t- data or rrrJunuatrar hrorrdecl ht DRdfS is "as is - i,,trlroru torr teurraI1tY ofcrrrr kind either <br />expl-eCs or implied im-111(hng but not limited f0, die imphe d tircurinuies of inerchamahil(tY eind faness for a pa•Ncular purpose Data or <br />information provided hr the DR,1IS slndl he used rand r e lead upon orrh' ar rhe users .soh. risk, and the user (rgrec s to indetni ifi� and holt! <br />harmless DR,11.S, its oflicials, officers and emplo.t ees_1r•orn roti, liuhilit- arising. front the use of the dura infornuuirnr proridc d. <br />D PX' 1)0 i de r ro rm S Sa, robe r 2017 <br />tai 90 <br />1311 Sherman Street, Room 215, Denver, CO 80203 P 303.866.3567 F 303.832.8106 http://mining. state. co. us I t14 fo <br />.John W. Hickenlooper, Governor I Mike King, Executive Director ' Virginia Brannon, Director <br />