2015-02-09_REPORT - M1990131

• Permit No: M1990131
• IBM Index Class Name: Report
• Doc Date: 2/9/2015
• Doc Name: Annual Fee Report and Map
• From: Mitchell Pit #2
• To: DRMS
• Email Name: TOD
• Media Type: D
• Archive: No

,.
Report for Hydrovac Slurry
Date: f f / ; - Department:
KerrNtGee
AFE, Cost
Inspector or
Center, Work
Project /Source Name
Volume (Barrels)
Foreman
Order#
U
Clean load (y /n)
(If not, stop and utilize CSI /Tower Rd. manifest for E &P exempt waste tracking)
Destiny Information
Hydrovac Company:; . t
n f
Facility hauled to
f'
Driver's Signature: `.. /
Inspector /Foreman Signature: -
Driver's Name
Location: - -�-- -r
(Road directions)
Please return completed form to EHS Department at Anadarko Petroleum Corporation via email scan or regular mail:
4000 Burlington Ave. Evans CO 80620
785 -691 -7788 ( cell) mike.dinkel(�4,anadarko.com
970 - 573 -0298 ( cell) paul.schtivarz(cianadarko.com
307 - 399 -3911 (cell) chart es.chase(_iianadarko.com