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© COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> S u s a-n Be <br /> ,r- m a L e r <br /> IMAGED DOCUMENTS REQUEST FORM <br /> Imaged documents can be viewed and downloaded free of charge online at <br /> https://dnrweblink.state.co.us/drms/search.aspx, or they can be purchased from DRMS. The purchase price <br /> includes costs for staff time related to data compilation and/or mailing costs. Data will consist of multiple pdf <br /> files and require the use of Adobe Acrobat Reader to be viewed. Please note that confidential bonding <br /> documents will not be included in the available files. The cost for file preparation is $10.00 per permit/file <br /> number. <br /> Please indicate the permit and/or file numbers for which you are requesting imaged documents: <br /> 1) M2 1)1 :5 -0-33 2) M? alb - o6 3) 2o1�-d4q 4) M 1999 - or <br /> Please indicate your preference below and return this form with your payment to the Division. <br /> IDVD �F�ectronic Folder Link Jr M 19 7A.05 h <br /> Mailing and Contact Information: <br /> Name: :B a�c c ,!2on e S <br /> Company Name: DRMS Use Only: <br /> Email Address: �I• �'�.S P;,r� p ,f-� -Y71 �31f1 _ G O rjl <br /> Mailing Address: S Completed by: <br /> (Street A ess) <br /> (City) (State) (Zip) (Name) <br /> Daytime Phone Number: q 7 _ �j S� � 10 <br /> ate <br /> Signature: <br /> Disclaimer-: <br /> The Colorado Division of•Reclanunron,Jimin",uncl.SuJety tDR_1l.SI a not rcsponwble and%haN not he liable to the user for dumu,CS of <br /> um'kntd oricnrs;out of the rice of data or infor•nrutron provided bl DR.1 X urclu(hnr,the nrsndlcuicnr of the data m1irrntutrort ltc nee,or <br /> the re tiN obtained horn u%noc. Ails chaa or information provided hr DRAN rc 'as n•• itithorrt unv xarl•cnut o!unr kind. erthcr <br /> eX7WON or inrpfced nrclud)>,but not finuted to the Implied xarrunnes u(nrerc lrcrntubrfitr curl finr0 c fw•cr purncrtfur pnlpose Alto or <br /> information provided by the DRAM shall he aced and relied upon onh•tit the a er arle rick and fire rner c{sees to ntdcnmrfi and hold <br /> Itunnlecs DKIIS. ns o%(icralc. officers and engrlovees fi•onr urrl hahilur arisoi,from the n<<>o%the dater mforrnrcuron provided <br /> DDl IN h da:Fum:�\o•rmhrr'H <br /> 1313 Sherman Street,Room 215, Denver,CO 80203 P 303.866.3567 F 303.832.8106 « « <br /> https://drms.colorado.gov/Jared S.Potis,Governor ) Dan Gibbs,Executive Director I Virginia Brannon,Director • IR7G <br />