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' ICOLORADO <br /> Division of Reclamation, ,R <br /> Mining and Safety cF'� <br /> i LX-L'ar,'Tlerit of Natu,at tResourres MNR� t® <br /> 1313 Sherman Street, Room 215 8 <br /> Denver, CO 80203 `� �F '?Q,'9 <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/ImagedDocurnentData.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 theermit and/or file numbers for which you are requesting imaged documents: <br /> Vs,I ate the <br /> W + <br /> 1) Al, l qt?7:3'19-3� 2) 3) 4) <br /> Please indicate your preference below and return this form with your payment to the Division. if a CD is <br /> requested and the data is too large for a CD,we will contact you. <br /> ® CD @$5.00 per disk(-700MB) DVD @$20.00 per disk(-4.7GB) <br /> Mailing and Contact Information: <br /> Name: - 61 ruc )L, 14 t° - n ✓' <br /> Company Name: DRMS Use Only: <br /> Mailing CD/DVD created and <br /> Address: 37 �. G'o l o-ret a o tested by: <br /> (Street Address) S3`�F <br /> .Dion V C Y Po c a 1 o Rscely= <br /> (City) Ntate) (Zip) (Name) <br /> Daytime Phone Number: '3 03 !� _ 96 96 MAR 18 <br /> Signature: / +Nlh Afi1ON <br /> s P, <br /> Disclaimer: <br /> The Colorado Division ofReclaanation.Mining cand Safety(DRb )is not responsible and shall not he liable to the user for clamages of <br /> any kind arising out of the use gI'data or information provided by DR15,including the Installation of the data Information,Its use. or <br /> the results obtained troan its use. Any data or information provided by DR-,W,is "as Is", withour my warremty of am,kmd. either <br /> erpre.ss or iniphed. including btu!not dunned to,the umpired riarrantie.s of naerchcrntabrltt-and fitness fir o purtic ulor purpose Datci or <br /> aj formation provided hY the DR.U1.5 shall he used and relied upon only at the user's sole risk-, and the user agrees to indemntft and hold <br /> haranle's DRIIX It.S ofctals, r)/lacet'.s drnd einplrltiee:,.f;'om ani labiIt ty art<in_q from the?ise of the data information proi iclecI <br /> �w�cOLop1. <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 ` 7s` <br />