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x <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 />DRMS cannot provide computer related support. <br />Address: p O. "Box 2 d $ <br />PlAy. e?L , Co, 8' / <br />Phone: ` 74 "' 7 Z- " 3.215 - <br />Signature: ) / ahAd <br />1 <br />Office of <br />Mined Land Reclamation <br />Document Imaging_OWDVD <br />REQUEST FORM <br />STATE OF COLORADO <br />Re uest for the DRMS document images on the following DRMS Permit file(s): <br />1� M - 1.0 -/4 / 2) 3 4 <br />The DRMS document images can bVcopied to eimer a CD or a D D. Pleas check one below and return <br />this form with your payment to DRMS. If a CD is requested and the permit i too large for a CD, Y ou 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 <br />they The Permit File document images can be viewed in the reception area of the DRMS office, online at www.uiining 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/1.14Er <br />f <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 />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: ✓ (a fe R L S r L e DRMS use only <br />Y CD/DVD ,< ted and <br />Company: l0d fFP r �I wies To Ike Ca. , Lye. R ested by <br />Denver • Grand junction • Durango <br />ate: <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />SAFETY <br />r <br />I a. 5 �o� 1150 <br />Office of <br />Active and Inactive Mines <br />