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08/25/2011 14:35 3035340310 <br />2011 -08 -25 10:55 DRMS <br />Depontnat at Nano' R.5ourts, 14 DIVISION OF RECLAMATION, MINING ANC) SAFETY , ! A I t)lA iet <br />/yl - ao 0 99 <br />1313 Sherman St., Roan 215 <br />Denver,. Colorado 110203 <br />Mono! (3031856-3510 <br />FAX: (303) 83I(•61043 <br />Document Imaging CD /DVD <br />REQUEST FORM <br />, / <br />vu ✓`ra akti p s <br />Request for the DRMS document images on the following DR14S Pen nit fmle(s): �o <br />West: � 2) tin ooQ $ 3) mt q o`iC 4) r `4`l 5 <br />!- }CtNTZ �Pi a5hNe Ur► rvl <br />The ORMS docutnetlt images can be copied to either a CD or a DVD, Please check one below and recur <br />this fnrm with your payment to DRMS. if a CD is requested and the permit is to large for a CD, you will be tattled. <br />Ct3 t $5.0O per di:4k — DVD $20.00 per disk <br />Please cheek if you want a copy of the Directions for Use of CD 1 VD <br />The Permit mile document images can be viewed in the reception area of the DRMS office, online at www,l fining i e,co,ua, or <br />they can be purchased on a CD or DVD, The CD/DVD purchase cups covers the time And tabor of making the CD/DVD. <br />7t-tat ° ,talstrudions: <br />1, insert CD /DVD into your disk drive <br />2, Click Yes to Accept the Licenses Agreement for Laserfiche Pius Viewer <br />4. Laserfiche will Load, Opening the Start Page <br />S. Click on the Available Repository and Click Open, You are now ready to view the ftle(s). <br />L1. <br />A I + . <br />I T I <br />can <br />Disclaimer; <br />The Colorado Division of Reclamation, Mining and Satbty (DRIVES) is 11,01 responsible and shall not be liable to the user fox <br />damages of any kind arising out of the use of data or information provided by the URMS, including the installation of'the data or <br />information, its use, or the wits obtained from its use. Any data or information provided by the DRAM is provided "Res <br />without wm'anty of any kind, either express or Implied, including, but not iitnitcd to, the implied warranties of merchantability <br />sod fitness for a particular purpose, Data or information provided by the DRMS shall be used and relied upon only at the) users <br />sole risk, and the user macs to indcranlly end hold harmless the DRMS, its officials, officers and employees from any liability <br />arising On of the use of the data/information provided. <br />Customer Maili:tg and Contact Information: <br />.Print NUM: n1C: Ms'r't" - ) G "Z C1 ay) G V 1 t^ <br />Company: �\ `t'OC 1 2t\841 , • � • <br />Address: Lc Cal t1\ 5tt; SU,''\ e. \ $0 <br />' 1, 4 —r\V_LKL4, C Bbd_ - <br />Phone: C>7. — .5 3 C) 1 0 <br />`kipuiture: <br />Office of <br />Mined !and Reclamation <br />C <br />3038328106 » 3035340310 <br />5TH ATE OF COLORADO <br />Denver • Grand )unctfon • uunrngo <br />PETROCK &FENDEL PC PAGE 01/01 <br />P1/1 <br />CO1.0RAt)0 <br />DIVISION ar• <br />RECLAMATION <br />MINING <br />sAp <br />Office of <br />Active and 1nocti, Minas <br />