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Nov. 2. 2010 3:07PM No. 1244 P. 2 <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 C o T. 4 R A D p <br />D I v 1$ r O N O F <br />Phone. (303) 866-3567 Document Imaging Cb/D VD RECrAMnTION <br />W; (303) 832-8106 MI N I,N G <br />REQUEST FORM -- <br />SAF FTY <br />Request for the DRMS document images on the following DRMS Permit file(s): <br />1) e119101b 2) 3) 4) `??vr0 <br />1.4h o It 191e I <br />The DBMS document images can be copied to either a CD or a DVD. please check one below and return <br />this form with your payment to DBMS. If a CD is requested and the permit is too large for a CD, you will be called. <br />CD $5.00 per disk DVD @ $20.00 per disk <br />c9a <br />Please check if you want a copy of the Directions for Use of CD/DVD <br />The Permit i+ile document images can be view.trl in the rectption.area of thp.DRMS.of It:e oi<1;line.at :ww:w.Itiinina.state.co:us; Or <br />x <br />they oari be ?iu:> -based on a CD or DVD. The Ci7/DVD pifiehase cost'c4v is the. ti. n .ari+3 la oi'.of rr a[ ittg, the`G'1affiVa. <br />Basic Ins'trub'ti(oris: <br />intp Our.disl-driVe, <br />2. Cli'akYgs tp Accepi tl•;;Tcense.Agr4exrigk fax;Jraerfl'g(ia;Plus Vleiyer <br />4. Last3rtahe w1x 1rJ:Aad? (?peiitn;'. Star#:lge:y <br />5. Click on thE:4yiiilable lZcpo - .......d Qlick''Qpen, You are now ready to'view thelile(s). <br />RMS cannot.bi#-4 ]Fe:comnu'te)rela'tei s>inpoit <br />Disclaimer: <br />the Colorado Division cif Reclafnation, Mjning anti. ,$afety (1. WS) is not responsible and shall not be liable t'o.:the 6sor fcji <br />damages of iiny krnd:si sing..out of thb use bf data or itifon -nation provided by the DRMS, including the installation.ofthe data .:r <br />i ,fOrmation, its use, or the results obtained from its use. Any data or information provided by the DRSM is 'provided "as'is" <br />without Warrant y•..f;any kind, either express or implied, including, but not limited to, the implied warranties of merchantability <br />ai1cf 'fitness for a pai#igutar liiiVose. Data or information provided by the DAMS shall be used and relied upon only at the user's <br />soXe,: sic, and the iise' akrees to indemnify and hold harmless the DBMS, its officials, officer,'s and employees from any liability <br />ari3?<out of the use of (lie data/informalion provided. <br />Customer Mailing and Contact Information: <br />RriItf `?"sme' ?c ?r.sr C? ??? ! (GlX t? <br />Cbnipanyc <br />f 1!l <br />Adili'ess:• -19C)o <br />Phone: I1).'S -- <br />use <br />created and <br />bate. <br />Signature: <br />office of <br />Mih0 Land Reclamation <br />Denver . Grand junction • Durango <br />Office of <br />Active and Inactive Mines