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COLORADO <br />Division of Reclamation, <br />Mining and Safety <br />Department of Natural Resources <br />1313 Sherman Street. Room 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 DBMS offices and <br />online at http://mining.state.co.us/ReportsIPagesiImagedDocumentData.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-2000-082 <br />2) M-2008-Oi7 3) M-1985-112 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) <br />Mailing and Contact Information: <br />Name: William Schenderlein <br />Company Name: Blue Earth Solutions <br />QX DVD @ $20.00 per disk (V4.7GB) <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: Z, <br />Disclaimer: <br />DRMS Use Only: <br />CD/DVD created and <br />tested by: <br />The Cc lon w?o Division of Reclamation. ,{lurrrrgand .S'alett (DR.11S) n tut re-sp wsihle atoll shall nrrt he liable ru [he user for dunruge.c of <br />arm kind at'ising ort o/ the use r f&na or nrlftr ruutiou proride(1 nt' DR.1LS. tncladmg the instctllatimr t fthe dcaa information, ormation, its use. or <br />the resales ohluined from its nse 4171' data nr infiornarlion lx oralt'cl hi-1,)R:11S is "cos is-- rl fllrort ani, rrarrantr' afarry kited, either <br />express or implied, including bort not !muted tn, the tnthlied L'arranfies of merchantahrlm- an(1ltness/a' a pa!•ticrdar purpose. Data or <br />infurmatiun prurided br the DR.11'C shall he usedand relied upon onit-dtt the rrsrr'a sale risk. and the user agrees to iadeamif, , urn/ hold <br />harmless DR,1 n. its officials, olfioers imd emploree s /l-cone urrT- hahilfn: ar•isiur; from tire use of the data/irrfiorrrurlinrr provided. <br />T)D%'DOrderPormSvoremlx:?! 17 <br />e� or. Coto <br />qS <br />1313 Sherman Street, Room 215, Denver, CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.ca.us I I * ` ■ <br />John W. Hickenlooper, Governor I Mike King, Executive Director I Virginia Brannon, Director } tsps " <br />