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2017-03-30_REPORT - M1987023
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2017-03-30_REPORT - M1987023
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Entry Properties
Last modified
12/18/2020 6:20:16 AM
Creation date
3/31/2017 8:01:44 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1987023
IBM Index Class Name
REPORT
Doc Date
3/30/2017
Doc Name
Annual Fee/Report/Map
From
Ricky W. Mitchell
To
DRMS
Annual Report Year
2017
Email Name
JLE
Media Type
D
Archive
No
Tags
DRMS Re-OCR
Description:
Signifies Re-OCR Process Performed
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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: 10 <br /> RF,t 4.w 01, '&AS(C4�P.W LI,L &)s4 5 r�Sr 5M zz kw 00 %Do 1(e <br /> Name of Drilling Company, City, State,Zip (please print) <br /> �►vi�esgMl S�crea Iw;T?s ,iZboN f foul,�t,o,4wa <br /> Well Location/Job Site of Drilling Fluid (please print) <br /> W�rR-Di b'1�6 u-144�wj D - 0 o GxP"'ly �DpW izBW.S <br /> Name/type of Material/Fluid (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 /> FUwv1 � <br /> Authorized Drilling mp Representative (please print) <br /> Date: 10-14-1(. <br /> Authorized Drilling Co any Representative signature <br /> r AX'6eip S5MV tE5 <br /> Name of Transport Company disposing of above material (please print) <br /> 6m We1lmGni1 <br /> Transport Company Representative (please print) <br /> ( 4t A � Date: ID-1 •16 <br /> Transport Company Representative signature <br /> Drilling Fluid Disposal/Destination: Mitchell Sand and Gravel Pits, Bennett CO 80102 <br /> Rick Mitchell, Owner <br />
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