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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 COLORADO <br />Phone: (303) 866-3567 <br />Document Imaging CD/DVD D IV IS I ON OF <br />RECLAMATION <br />FAX: (303) 832-8106 <br />REQUEST FORM MI &NG <br /> <br /> SAFETY <br />Request for the DRMS document images on the foll7ing DRMS Permit file(s),: <br />1)? -/97 -22710)69 "M-2008-0123) P.ZO07-657 4) hl- /977-7-93 <br />,1 5r) M- zoos-0 5D ?) P-2no$-os3 <br />The DRMS e copied to either a CD or a DVD. Please check one below and return <br />this form with your payment to DRMS. 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 />Please check if you want a copy of the Directions for Use of CD/DVD <br />The Permit File document images can be viewed in the reception area of the DRMS office, online at www.mining.state.co.us, or <br />they can be purchased on a CD or DVD. The CD/DVD purchase cost covers the time and labor of making the CD/DVD. <br />Basic Instructions: <br />1. Insert CD/DVD into your disk drive <br />2. Click Yes to Accept the License Agreement for Laserfiche Plus Vie•% er <br />4. Laserfiche will Load, Opening the Start Page <br />5. Click on the Available Repository and Click Open, You are now ready to view the file(s). <br />DRMS cannot provide computer related support. <br />Disclaimer: <br />The Colorado Division of Reclamation, Mining and Safety (DRMS) is not responsible and shall not be liable to the user for <br />damages of any kind arising out of the use of data or information provided by the DRMS, including the installation of the data or <br />information, its use, or the results obtained from its use. Any data or information provided by the DRSM is provided "as is" <br />without warranty of any kind, either express or implied, including, but not limited to, the implied warranties of merchantability <br />and fitness for a particular purpose. Data or information provided by the DRMS shall be used and relied upon only at the user's <br />sole risk, and the user agrees to indemnify and hold harmless the DRMS, its officials, officers and employees from any liability <br />arising out of the use of the data/information provided. <br />Customer Mailing and Contact Information: <br />Print Name: ?PrU L S -Z1 LA &I I <br />Company: IS U \F' £A C-0 / u- C <br />Address: G SJ V W N 1, S43 A\j <br />ToQ0)Wo co jb? d 4- <br />Phone: b? 4 3 I0 0.6 <br />i <br />Signature: <br />(JO <br />DBMS use only <br />CD/DVD created and <br />tested by: <br />Date: 9-5 -11 <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines