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STATE OF COLOF ADO <br />p1VISION Of RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 p SI F LA OQ <br />Phone: (303) 660567 Document Imaging <br />b/DVD kECLAMATION <br />FAX: (343) 832-8106 C <br />REQUEST FORM MINING <br /> <br /> SAFETY <br />Request for the DRMS document images on the following DRMS Permit file(s): <br />U D 2) 3) a) <br />i he D S c'o xeni CAacB canlj6 copied to Ciu`iZr & Ciivr a" V i.lea3c check one below and raiili <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 c(?r $5.00 per disk ) c@7i $20.00 per disk <br />40f' <br />P <br />icasc check if you want a copy of the Directions or Use of CD/DVD <br />The Perrjrdt-Ele document- imal es can tic. vicwcd in•the'reception•area of the DRMS of wd, ynlind•'at"'txnx+•w.rtainins_state.ca::tts, or. <br />they can. be, purchased ona' CD or. END. The CD/DVI) purchase cost covers the-time. and Iab6i of itialcing. the Cl)/.DVD: <br />Basic_instrueti_aris: RECEIVED <br />I. Insert C17/DVD. into your, disk driyc; 1 <br />2. Click :Yes;to:Accept•tlie'L'icensc Agreemcni:for La§er ckie PJ.us Viewer <br />4. Laserfichevill.16ad,:Opening the Start. Pace FEB 2 8 2011 <br />-S. Click on the• Lvaili6le Repository and:Click-Open, You are now ready to-view:the file(s). <br />DRMS cannot-prowide•coMutex related support: <br />D W Ion of Reclamatloe, <br />Mining & Safety <br />Disclaimer. <br />The Colorado .Division- of .Reclamation;, Mining and Safety (DBMS) is .not i6sp6nsibie• and skull :not' be 'liable, to the riser for <br />damages of any ki-nd arising :out of the use of,daia 'or infonwtlon. provided byt}ie• DRM.S.iincluding Lh instalTaCion of tl?e data ox <br />information, its use,, or the results obtained: fromJts;use.• ,Any data. or information•provided..by the•DRSM•is„provided•"as :is" <br />without warranty of any kind, cithdr express or• implied; including, but not-limited. to, th6 implied warranties. of mc,rchantability <br />and fitness for a particular purpose- Datai or information,provided-by the.DXtMS.shaff bemsed and, relibd upon• :only at tkl 'user's <br />sole xisk, and the 'user agrees•to; indcmnifyand. hold harxnless•.tkte DRNIS,-its offiicials,;officers, and employees: fxoi i arty liability <br />arising out of the- use' of.•the:datAlixtf6nnatiati provided.• <br />Customer Mailing acid Coritact..Infoi nation: <br />Print Name: Gtr 1r )/ (l !// f, S C <br />Company. <br />Address: <br />FCY l C0,/ ,7 5,..Gd <br />Phone: <br />Si?nat urc_ "' <br />Office of <br />Mined Land R6Clarh4gn <br />Denikr • Crand Junction • Durango <br />DRMS•use. <br />CDIDVD created and <br />ostco.vy.. /1 <br />•,?,/? F s <br />',QElige.pf, <br />Acute and Iiiactivemi.nes <br />Z00/ Z00'd t99S# T6ZE£ZZOL6 ST:60 TTOZ'BZ'Hdd