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Customer Mailing and Contact Iriformat' <br />Print Name: ke) L e [' i GZ <br />Company: L q A r e l�eS z , <br />5 <br />Address: 10/70 C r Q /1/I "Gt Y/ Sk, 4.2-C 0 <br />tAiesi s 7 t � . foa ,2/ <br />.3 v 3 - (0,6'7- I <br />Phone: <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />Signature: <br />Office of <br />Mined Land Reclamation <br />Document Imaging CD/DVD <br />REQUEST FORM <br />Denver • Grand Junction • Durango <br />STATE OF COLORADO <br />C O LO RAD <br />DIVISION OF <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />Request for the DRMS document images on the following DRMS Permit file(s): -- i 7 sI f e <br />1) 2) '4 t$ee ICJ / t 4) 7 <br />The DRMS document images can be copied to either a CD or a DVD. Please check one below and retum <br />this for with your payment to D S. If a CD is requested and the permit is too large for a CD, you will be called. <br />/ 7 . 5 <br />CD @ $5.00 per disk ry . DVD @ $20.00 per disk <br />i <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 Viewer <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, arid,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/inforrnation provided. <br />DRMS use only <br />CD/DVD _ ted and <br />tested <br />JAI <br />Date:1 /'°21 // <br />Office of <br />Active and inactive Mines <br />