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08/25/2011 14:35 3035340310 <br />2011 -08 -25 10 ;55 DRMS <br />ENVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Reabur ea <br />1313 Sherman St., Rooin 215 <br />Denver, Colorado 8O203 <br />Phone (303) 856 -351:7 <br />FAX: (303) B3241106 <br />Request for the DBMS document images on the following DBMS Permit flie(s): �D <br />W cST' 2 3; U / z 14C- i N gar M�v r R� L 0'161 4) m 1 <br />TZ�L �/Ve fur► <br />The DBMS document images can be copied to either a CD or a DVD, Please cheek 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 culled. <br />Ct) t $5.00 per disk DVD @ $20.00 per disk <br />Plcas+r check if you want a copy of the Direction for Use of CD(DVD <br />The Permit File document usages can be viewed in the reception area of the ORM,S, office, online at yvww,miningatatiLmgg, or <br />they can be purchased on a CD or DVD. 'l~be CD/DVD purchase coat covers the time and tabor of making the CD/DVD. <br />lnstmotionsa <br />1, insert CD /DVD into your dish drive <br />2, Click Yea tc, Accept the License Agreement for Lnserticho Plus Viewer <br />4. Leserftche will Load, Opening the Start Page <br />5. Click on the Available Repository and Click Open, You are now ready to view the flic(s). <br />ARMS cannot nravva c computes related support. <br />Disclaimer; <br />The Colorado Division of Reclamation, Mining and Satbtyr (DBMS) is net 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 DBMS, including the installation of the data or <br />intbrcnationl, its use, or the results obtained from Its use. Any data or information provided by the DRtilul is provided "as ire' <br />without warranty of any kind, either express or implied, including, but not limited to, the implied watranties 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 a rcea to haler ifs 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: '\--\-' G Z r7 Os) 0 V \ C <br />Company: _ e,,,t„_(, 1 R . c. <br />Address: 0 t th Std 2st �t ,_ _ c. $ o g <br />Office or <br />Mined (,And Redani ztlnn <br />c <br />Phone: 3 G j- 5 3 -- 07 O e . <br />Skip iature: <br />3038328106 » 3035340310 p 1/1 <br />5TATE CAF COLORADO <br />. 1 1 ; 1 , 1 , bmplet <br />/97-a <br />Document imaging CD /DVD <br />REQUEST FORM <br />Deaver • Grand lunctron A uurAn <br />PETROCK &FENDEL PC PAGE 01/01 <br />OLOI,Abo <br />htVisioN or. <br />RECLAMATION <br />MINING <br />sAprre <br />DBMS use only <br />CD/DVD created and <br />sted ,. _ <br />Date: F <br />Mee of <br />Active one Inoolve Mints <br />