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} <br /> C O L O R A D O "3Jb$(INV JN1N,W <br /> Division of Reclamation, °� _ °,_- NO <br /> 11VWb703N d0"01.WAIG <br /> Mining and Safety ' <br /> f :�;�.�� ._-:r�f rr���•.�-x_z: ,_,.�Fvs 1°�,i ,, � '; gi�� � � PAY(' �� <br /> 1313 Sherman Street, Room 215 <br /> 3 . <br /> Denver,CO 80203 <br /> IMAGED DOCUMENTS CD/DVD REQUEST FORM <br /> Imaged documents can be viewed and downloaded free of charge in the reception area of the DRMS offices and <br /> online at http://mining.state.co.us/Reports/Pages/ImagedDocumentData.aspx,or they can be purchased on a CD <br /> or DVD. The CD/DVD purchase price includes costs for staff time related to data compilation and mailing <br /> costs. Data on the disk will consist of multiple pdf files and require the use of Adobe Acrobat Reader to be <br /> viewed. <br /> Please indicate the permit and/or file numbers for which you are requesting imaged documents: <br /> 1) 5S Z2) 3) 4) <br /> Please indicate your preference below and return this form with your payment to the Division. If a CD is <br /> F <br /> e data is too large for a CD,we will contact you. <br /> 0 per disk(-700MB) DVD @$20.00 per disk(-4.7GB) <br /> ntact Information: <br /> Name: IVA-MQj 1 1KIM <br /> Company Name: �,4ko'L? e(.A N Gj C_w LLy4, 1 0, DRMS Use Only: <br /> Mailing CD/DVD created and <br /> Address: . O, OP� w3;�-2 2- Z 24 :>T tested by- <br /> _ (Street Address) <br /> ��� K Cc-----) 63 <br /> (City) (State) (zip) ame) <br /> Daytime Phone Number: o <br /> ate <br /> Signature: <br /> Disclaimer: <br /> The Colorado Division of Reclamation. Afinin,and Safeh•!DRAM is not responsible and shall not be liable to the user fir r dcunages of <br /> ant kind arising out of the use of data or inlornuttion provided by DRAIS, including the installation of the data information. its use, or <br /> the results obtained from its use Am' <br /> data or information provided bi DRAIS is "as is without ani ivarrann.ofanv kind,eitherexpress or implied, including but not limited to,the implied warranties of nierchcnitability and fitness fior a particular purpose Data or <br /> information provided by the DR.1 LS shall be used and relied upon only at the users sole risk,and the user agrees to indeninif and hold <br /> harmless DRAM, its officials,officers and emplQ ees from any liability arising from the use of the data information provided. <br /> OF Crjl� <br /> 1313 Sherman Street,Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.CO.us <br /> John W.Hickentooper,Governor I Mike King, Executive Director I Virginia Brannon,Director <br /> ig76 . <br />