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COLORADO <br /> Division of Reclamation,A;G RECEIVED <br /> Mining and Safety <br /> Department of Natural Resources <br /> DEC 14 2021 <br /> Colorado Division of Reclamation, <br /> Mining and Safety <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) M-2000-077 2) 3) 4) <br /> Please indicate your preference below and return this form with your payment to the Division. <br /> US13 Flash Drive X� Electronic Folder Link <br /> Mailing and Contact Information: <br /> Name: Sydney Connor <br /> Company Name: Lewicki &Associates DRMS Use Only: <br /> Email Address: sydney@lewicki.biz <br /> Mailing Address: NA Completed by: <br /> (Street Address) <br /> (City) (State) (Zip) (Name) <br /> Daytime Phone Number: (719)323-9867 <br /> ate <br /> Signature: <br /> Disclaimer: <br /> The('olorado Division oj'Reclamation, kfining and Safety(DR,1LS)is not responsible and shall not be liable to the user for damages of <br /> am kind arising out of the use of&ita or it formation provided by DRIN, inhaling the installation of the data information, its use, or <br /> the results obtained from its use At1v data or infarmauon provided by I)RUS is "as is without tin),wurranty of anP kind either <br /> express or implied including but not limited to, the implied warranties n/merchantability and fitness for a particular purpose. Data or <br /> information provided by the DR,,WS shall be used and relied upon only at the user's sole risk,and the user agrees to indemnify and hold <br /> harmless DRWS. its o f vials, officers and employees from any liability arisen, from the use of the data information provided. <br /> -DU�DOrderlumifi'vo�amUer3U 17 <br /> 1313 Sherman Street, Room 215, Denver,CO 80203 P 303.866.3567 F 303.832.8106 f'•*\', a°-I*r <br /> httos://drms.colorado.Qov/Jared S. Polis,Governor I Dan Gibbs, Executive Director I Virginia Brannon, Director7s <br />