Laserfiche WebLink
Mitchell Sand and Gravel, <br />48580 Hwy 36 - P.O. Box 10, Bennett, CO 80102 <br />303-644-4102 303-870-4260 cell <br />A disabled American veteran owned company <br />Authorization Form for Disposal of Water Based Bentonitic Drilling Fluids <br />as required by the Colorado Division of Reclamation Mining and Safety <br />Date: 6/15/2015 <br />Denver Transit Partners <br />Name of Drilling Company, City, State, Zip (please print) <br />Federal Blvd. & 64th Ave., Arvada, CO <br />Well Location/Job Site of Drilling Fluid (please print) <br />Captured Ground Water <br />Name/type of MateriaVFluid (please print) <br />Drilling Company guarantees that all material to be disposed of is both non -hazardous <br />and non -harmful to soil and/or crops, etc. pursuant to all applicable Federal and State <br />of Colorado Regulations, including Rule 907 of the Colorado Oil and Gas Conservation <br />Commission. <br />Earth Services & Abatement, Inc. <br />Authorized Drilling Company Representative (please print) <br />Authorized Drilling Company Representative signature <br />D & D Water Service, LLC <br />Date: <br />Name of Transport Company disposing of above material (please print) <br />�oJ <br />Transport Company Representative (please print) <br />Trans.. v Company Representative signature <br />Date: / 7 /5 - <br />Drilling Fluid Disposal/Destination: Mitchell Sand and Gravel Pits, Bennett. CO 80102 <br />Rick Mitchell, Owner <br />