HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8'" Street, Suite 401
Glenwood Springs, CO 81601
(970)945-8212
www.garfeeld-county.com
SMALL TEMPORARY
EMPLOYEE HOUSING
APPLICATION FORM
This Application form must be completed and received by the Garfield County Community Development
Department within 48 hours following occupancy of the Small Facility. In addition, documents shall be
provided to the Sherriff's Office and relevant fire protection district(s) that demonstrate and certify
compliance with the following standards. Notice shall also be provided to these entities within 48 -hours
following removal of a Small Facility. It is the Operator's responsibility to confirm and obtain verification
that this Application has been received by the Sheriffs Office and Fire Protection District.
INVOLVED PARTIES
Property OwnerName: Bureau
of Land
Management 876-9000
Mailing Address: Colorado River Valley Field Office 2300 River Frontage Road
City: Silt State: CO Zip Code: 81652
E-mail:
Operator's Compliance Officer
Name: TEP Rocky Mountain LLC Phone: ( 970 ) 285-9377
Mailing Address: PO Box 370
City: Parachute State: CO Zip Code: 81635
E-mail: kaylee.mcintosh@wpxenergy.com
PROJECT NAME AND LOCATION
Location of Housing Site (Section/Township/Range): S9 T7 R93
Well Pad Number: MV 16-9 Assessor's Parcel Number: 240921200952
Zone District: Rural Maximum Number of Permitted Occupants: less than 8
Number of Days the Facility will be at Location: 66
State or Federal Permitting Agency Overseeing Reclamation, Restoration and Revegetation (Name):
(Name): BLM (Relevant Permit Number): API # 05-045-22526-00
Date of Installation: 05/25/2016 Date of Removal: 07/25/2016
24 -Hour Emergency Contact (1): I LF KOCKy Iyiouniain LLG Phone Number: U t u ZZJD-`J3/
24 -Hour Emergency Contact (2): Phone Number:
ELIGBILITY
During times of housing shortage or in remote locations, the use of Factory Built Nonresidential
Structures (as defined under C.R.S. § 24-32-3301, as amended, and Resolution #35 of the Colorado State
Housing Board) utilized for a period of time not longer than 1 year or as otherwise specified, for workers
who are engaged in commercial, industrial, mineral extraction, or highway operations and who are
needed to support the proper execution and safety of the related operations. Temporary Employee
Housing, shall not include Recreational Vehicles, except in a Small Facility. A Small Temporary Housing
Facility shall have all of the following basic characteristics:
Complies Y/N
1. The Small Facility and any associated Infrastructure must be completely
Yes
contained within a State or Federally -permitted parcel (such as a COGCC-
approved oil/gas well pad) in which reclamation and revegetation are secured
with the permitting agency (Permitted Site); and
2. The Small Facility is located at the Permitted Site for less than a cumulative of 1
Yes
year and at the end of the utilization period, all structures, foundations, and
associated infrastructure are completely removed; and
3. The Small Facility shall have an occupancy of 8 or fewer people who are
Yes
employees, contractors, or subcontractors of the operator of the small facility
and are needed for on-site safety of the related commercial, industrial,
extraction, or highway operation.
SUBMITTAL REQUIREMENTS.
The application submitted to the County shall contain the following information:
1. A vicinity map indicating the section, township, and range of the subject lot and the location of Small
Facility within the subject lot and the Permitted Site; general relation to surrounding public roads,
private roads, adjacent utility systems, residential development, other actively permitted Small, Minor
and Major Facilities, natural drainage courses and municipalities within one (1) mile of the proposed
Small Facility; north arrow and scale; GPS coordinates and current surface ownership of the subject lot.
The vicinity map shall be presented on a USGS 7.5 minute series quadrangle at a scale of V=2000' or
equivalent, with a topography depicted at a minimum of 40' intervals.
2. Surveyed layout of the proposed Small Facility within the surveyed boundaries of the Permitted Site,
including at a minimum: sewage and wastewater disposal, trash receptacles, potable water storage, all
other associated Infrastructure and all other equipment located within the Permitted Site.
3. Identification of the private and public roadways accessing each Small Facility. Roadways shall be
marked as open, gated, and/or locked (include combinations). Detailed directions, with mileage, shall
be given from the nearest town within Garfield County, nearest Garfield County Sheriffs Office dispatch
location and responsible fire district headquarters to each Small Facility, along each roadway.
1. Small Facilities shall comply with all applicable Federal, State (i.e. Building Codes and electrical
permits), and local laws and regulations (i.e. fire code), but are not subject to County Building
Permit.
2. Water Systems.
a. Water systems shall comply with standards set forth in section 7-705.8. Water systems must
comply with all applicable State and local laws and regulations.
b. All potable water systems must include a meter and the Operator must keep a record of the
daily usage.
C. For sites to which potable water is hauled, Operators shall:
Keep appropriate records, to be provided to the County upon request, to demonstrate
that water supplied to a site is from an approved source and that wastewater is
disposed at an approved facility.
ii. For water facilities not permitted by the CDPHE, the Operator must conduct monthly
tests (or quarterly if an on-site disinfection system is installed) and maintain records of
potable water samples specific for coli form. Any tests indicating coli form
contamination must be disclosed to the County Public Health Department.
Ill. Water systems facilities permitted by the CDPHE must obtain all necessary State permits
or demonstrate that applications for any necessary permits have been submitted prior
to a determination by the County that an application is complete.
iv. Maintain compliance with State regulations at all times during operation.
d. In no case shall unsafe water be used for drinking nor shall raw sewage or used water be
discharged onto the ground surface.
3. Wastewater Systems.
a. Wastewater systems shall comply with standards set forth in section 7-705.C. Wastewater
systems must comply with all applicable State and local laws and regulations.
b. Wastewater may be disposed of using either an OWTS or a vault -and -haul system. A vault -
and -haul system must demonstrate the following:
I. Year-round access is available and maintained for safe and regular access for sewage
hauling vehicles;
ii. The Operator can demonstrate and guarantee an arrangement for hauling sewage;
iii. The Operator will maintain all records, including but not limited to, trip logs/reports and
landfill receipts;
iv. The sewage disposal records will be maintained as public records to be available to the
County upon request;
V. The facility will not exceed a cumulative of 1 year at the approved location; and
4. The facility has been designed to accommodate 75 gallons of wastewater per person per day or an
amount derived from engineered calculations taken from metered usage rates at a similar facility
that has been reviewed and approved by the County.
S. Each Small Facility shall be maintained in a clean, safe, and sanitary condition, free of weeds and
refuse. Any hazardous or noxious materials that must be stored at the Small Facility for operational
or security reasons must be managed in accordance with all applicable Federal, State, and local laws
and regulations.
6. Wildlife -proof refuse containers must be provided for trash. Outdoor food storage is prohibited
unless facilities are provided that prevent the attraction of animals to the Major Facility site.
7. Fire Protection and Suppression.
a. Provisions for giving alarm in case of fire and fire suppression must be installed per fire codes
and as required by the fire protection district.
b. Single -station carbon monoxide alarms must be placed in each Manufactured Home or
Recreational Vehicle unit.
C. A water storage tank is required to provide water to the sprinkler system (if applicable) and
initial suppression activities. The size of the water tank shall be determined based on sprinkler
calculations and initial suppression demands. The relevant fire protection district shall be
responsible for determining the size of the water storage tank. If the Small Facility is not
within a fire protection district, the Operator shall provide at least 2500 gallons of water
dedicated to initial fire suppression which is accessible with a dry hydrant. Required Size of
water storage tank for sprinkler system and initial suppression activities:
550 BBU21,000 gallons
8. Domestic animals are prohibited.
9. The Operator shall obtain a certification inspection conducted by a qualified professional engineer.
The certification shall verify that at the time of inspection the identified Small Facility meets or
exceeds the requirements of this section.
BUILDING INFORMATION (per unit)
Unit 1 — - —
Make:
Serial Number/Unit ID #:
Division of Housing Insignia (provide copy)
Square feet of unit:
Unit 2
Make:
Serial Number/Unit ID #:
Division of Housing Insignia (provide copy)
Square feet of unit:
Unit 3
Make:
Serial Number/Unit ID #:
Division of Housing Insignia (provide copy)
Square feet of unit:
OWTS PERMIT
Permit #:
I hereby attest that I am the designated Compliance Officer for the aforementioned Small Temporary
Employee Housing Facility. I attest that I have read and understand the standards to which the Facility
shall be installed and operated and that the Facility shall be constructed and maintained in
accordance with all applicable Garfield County, State of Colorado and Federal Regulations and
standards. I have read the statements -above and have provided the required attached information
which is correct and accurate to t }fest of my knowledee.
Signature of Com�Officer Do/to
I hereby attest that I am a Licensed Professional Engineer in the State of Colorado and that I have
conducted a visual inspection of the installed Small Temporary Housing Facility identified in this
application. Based upon my inspection, I certify that the Small Temporary Housing Facility complies
with the standards as forth above and as codified in the Garfield County Land Use and Development
Code.
PE Certification Number:
PE Stamp
Date of Inspection:
Name and Title:
Signature
OFFICIAL USE ONLY
File Number: ___--- __— Fee Paid: $_ n/a
From: McIntosh, Kaylee
To: orrin.moon(Merfr us
Cc: "Mewshaw, Mark"; Cass.Lynn; Hatard. Bryan
Subject: *** MV 16-9 Pad *** Rig Move On Notification
Date: Thursday, May 12, 2016 10:15:00 AM
Attachments: Colorado River Fire Rio On Notification MV 16-9 odf
This email is intended to notify you of the attached pad location. TEP Rocky Mountain LLC (formerly
WPX Energy Rocky Mountain, LLC) will be commencing drilling operations by 05/25/2016 and will
continue for approximately 66 days. At which time I will notify you of the removal of the employee
housing.
This notification is per GARCO regulations for the pad located in Sec 09 -T75 R96W. Please see the
attached map with directions, the pad lay out and emergency contact information.
Should you have any questions please let me know.
Thank you,
Kaylee McIntosh I Engineering Technician I WPX Energy, Inc.1 1058 County Road 215 1 Parachute, CO 81635
(Office) 970.263.27311 12 (Mobile) 970.623.9452 1 ® kavlee.mcintosh0woxenemv com
WPXENERGY.
WWPNWW—
TEP Rocky Mountain LLC
1058 County Road 215
P.O. Box 370
Parachute, Colorado 81635
(970)285-9377
May 3rd, 2016
Colorado River Fire Protection District
Emergency Operations
Attn: Fire Marshall Moon
5255 County Road 335
New Castle, CO 81647
Ph: 970-984-3323
RE: Emergency Response Notification
MV 16-9 pad
Dear Fire Marshall Moon:
This letter is to inform the Colorado River Fire Protection District that TEP Rocky Mountain LLC
(Formerly WPX Energy Rocky Mountain, LLC) will soon commence drilling operations on the
above mentioned drilling location. TEP will provide rig site housing accommodations for the
duration of the drilling operation approximately 66 days.
In accordance with Garfield County Planning and Zoning Regulations the attached
documentation provides emergency response information and driving directions for the
MV 16-9 pad.
Should you have any further questions or concerns regarding this notification feel free to
contact me.
Sincerely,
kUwjr u 04. Mc lmt0sh
Kaylee McIntosh I Engineering Technician 1 1058 County Road 215 1 Parachute, CO 81635
2 (Office) 970.263.2731 12 (Mobile) 970.623.9452 1 H kavlee.mcintoshCalwoxenerov.mm
MV 16-9 `VELL PAD
The well pad site is located in the NW 1/4 NW 1/4 of Section 09, T7S,1196W, 6th P.M.
(Lat: 39.465823 Long -108.120012)
Emergency Contact List:
Main Office: (970) 285-9377 answered 24 Hours
Lyme Cass: Drilling Sun (970) 755-0083 Cell
Mark Mewshaw� Drilling & Completions Manager (304) 612-7844 Cell
Kevin McDermott: Safety (970) 309-1195 Cell
Tim Dobransky,SIjill Contractor (970) 263-6032 Cell
This site will temporary office and house up to a maximum of 8 individuals during
natural gas drilling activities and is expected to complete in less than 6 months. The
individuals will occupy 2 individual trailer offws/houses located on the well pad.
One above ground water tank of approximately 500 Barrels capacity on each site.
One potable above ground water tank of approximately 4000 gallons capacity
on-site. Potable water demand is estimated to be 300 gallons/day (4 individuals
x 75 gpcd). Required minimum fire suppression demand is 2500 gallons. Total
potable and fire suppression volume required is estimated to be 400 gallons.
Water supply appear adequate with 4000 gallons of storage with refills
scheduled at 5 -day intervals. Dry hydrants observed on water tank.
ACCESS DESCRIPTION:
FROM THE INTERSECTION OF THE 1-70 FRONTAGE ROAD AND COUNTY ROAD 215 AT PARACHUTE, PROCEED IN A
NORTHWESTERLY DIRECTION ALONG COUNTY ROAD 215 t2.1 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD,
PROCEED LEFT IN A SOUTHWEST TO NORTHWESTERLY DIRECTION t1.7 MILES TO A THREE-WAY INTERSECTION,
PROCEED LEFT IN A SOUTHWESTERLY DIRECTION t1.8 MILES TO THE EXISTING MV 16-9 LOCATION, AS SHOWN HEREON.
Section 8
T. 7S, R 93 W.
0 1000 2000
GRAPHIC S®
1 INCH= 20M FEET
ACCESS DESCRIPTION:.
FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 323 (RULISON ROAD) NORTH OF RULISON, PROCEED
SOUTHERLY ALONG COUNTY ROAD 323 (RULISON ROAD) 11.1 MILES TO THE INTERSECTION WITH COUNTY ROAD 309 (RULISON
PARACHUTE ROAD), PROCEED LEFT IN AN EASTERLY DIRECTION 12.3 MILES TO THE INTERSECTION WITH COUNTY ROAD 320
(RIFLE RULISON ROAD), PROCEED RIGHT IN AN EASTERLY DIRECTION 16.2 MILES TO THE INTERSECTION WITH COUNTY ROAD
317 (BEAVER CREEK ROAD), PROCEED RIGHT IN A SOUTHERLY DIRECTION 13.6 MILES TO AN INTERSECTION WITH A
DIRT/GRAVEL ROAD, PROCEED LEFT IN AN EASTERLY TO NORTHEASTERLY DIRECTION 12.7 MILES TO AN INTERSECTION WITH A
DIRT/GRAVEL ROAD, PROCEED RIGHT IN A SOUTHRLY DIRECTION 10.2 MILES TO THE RU 21-6 DRILL PAD LOCATION, AS SHOWN
HEREON.
tab east na.d &Ret
Rifle, Colorado 81650 ��
Fh 1070) 625-2720 -
3CAL9.
DATE:
PLAT.
r" = 2000"
10/ 15114
5 off
U
WPX Energy Rocky Mountain, LLC
Fax (970) 6252TL?
I
RU21-8 DriLI Pad - Plats
\ I
PROJECT.
Valles
DFT.'
oats
ACCESS ROAD & TOPO MAP
Section 8 1 T #3
T. 7S., R 93 W. TO F 0.1
TO %-
i
x
/ r
,
�3A %
T
01.1
' Proposed/
// VOC Unfit' i / / o -
/' Proposed ,' / GRAPHIC; 86ALE IN FEET
ACCe7 Hoed / 2 , / 11,yo /' 1 INCH=100FEET -
/ T➢>
/
Edge of
H'm /
v ,' /Proposed P9d,
r
Daylight Line
Cut/Fill LinEe
,0954�'
0
e�o(yedeetVoX
n
�e�h�7
Ito
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/
ESTIMATED EARTHWORK QUANTITIES (cy)
ITEM
CUT
FILL
TOPSOIL
EXCESS
PAD
23950
16940
7500
X90
PIT
19300
WPXENERGY
� WPX Energy Rocky Mountain, LLC
mMrddo
Rifle, Colorado 81630
19300
OTAL
43250
16940
7500
18810
of ,' DaylWhWne
n � •
'NOTE:
1.) Topsoil Volume Based on 12" Soil Depth.
2.) 10% Swell Factor Applied to Earthwork Cut Volume.
3.) Total Disturbed Area = 37.74 ac.
/ RAVISED 612/75 Construction Plan Pre ared for:
p
,as East sneer
CALE:
r=ion
WPXENERGY
� WPX Energy Rocky Mountain, LLC
mMrddo
Rifle, Colorado 81630
�ATE:
]0/75/]4
Ph. (970) 625-2720
LAT.
2 of 7
Paz (970) 625,2773 IJff
RO✓ECZ`
uaueu
RU21-BDrillPad - Plat2
PT
cws
CONSTRUCTIONLAYOUT
From: McIntosh, Kaylee
To: jsears(ftarcosheriff.com"
Cc: "Mewshaw, Mark"; Cass. Lynn; Hotard. Bryan
Subject: *** MV 16-9 Pad *** Rig Move On Notification
Date: Thursday, May 12, 2016 10:14:00 AM
Attachments: GARCO Sheriff Rig On Notification MV 16-9.odf
This email is intended to notify you of the attached pad location. TEP Rocky Mountain LLC (formerly
WPX Energy Rocky Mountain, LLC) will be commencing drilling operations by 05/25/2016 and will
continue for approximately 66 days. At which time I will notify you of the removal of the employee
housing.
This notification is per GARCO regulations for the pad located in SEC 09 -T7S R96W. Please see the
attached map with directions, the pad lay out and emergency contact information.
Should you have any questions please let me know.
Thanks,
Kaylee McIntosh I Engineering Technician I WPX Energy, Incl 1058 County Road 215 1 Parachute, CO 81635
9 (Office) 970.263.273112 (Mobile) 970.623.9452 I ® kaylee.mcintoshrolwoxenemv corn
WPXWMIWWW�—
TEP Rocky Mountain LLC
1058 County Road 215
P.O. Box 370
Parachute, Colorado 81635
(970)285-9377
May 3`d, 2016
Garfield County Sheriff's Office
Emergency Operations
Attn: Jim Sears
1078 th Street
Glenwood Springs, CO 81601
Ph: 970-945-0453
RE: Emergency Response Notification
MV 16-9 pad
Dear Jim:
This letter is to inform the Garfield County Sheriffs Department that TEP Rocky Mountain LLC
(Formerly WPX Energy Rocky Mountain, LLC) will soon commence drilling operations on the
above mentioned drilling location. TEP will provide rig site housing accommodations for the
duration of the drilling operation approximately 66 days.
In accordance with Garfield County Planning and Zoning Regulations, the attached
documentation provides emergency response information and driving directions for the MV 16-
9 pad.
Should you have any further questions or concerns regarding this notification feel free to
contact me.
Sincerely,
01/1( cu 0. AA, lMtosh
Kaylee McIntosh I Engineering Technician I WPX Energy, Snc.1 1058 County Road 215 1 Parachute, CO 81635
2 (Office) 970.263.2731 12 (Mobile) 970.623.9452 1 H kavlee.mcintosh(olwoxeneray.com
MV 16-9 WELL PAD
The well pad site is located in the NW 1/4 NW 1/4 of Section 09, T7S, R96W, 6th P.M.
(Lat: 39.465823 Long -108.120012)
Emergency Contact List:
Maw Office: (970) 285-9377 answered 24 Hours
Lymt Cass: Drilling Sap (970) 755-0083 Cell
Mark Mewshaw, Drilling A Completions Manager (304) 612-7844 Cell
Kevin McDermott: Safely (970) 309-1195 Cell
Tim Dobraaft Spill Contractor (970) 263-6032 Cell
his site will temporary office and house up to a maximum of 8 individuals during
dural gas drilling activities and is expected to complete in less than 6 months. The
dividuals will occupy 2 individual trailer offices/houses located on the well pad.
no above ground water tank of approximately 500 Barrels capacity on each site.
ne potable above ground water tank of approximately 4000 gallons capacity
i -site. Potable water demand is estimated to be 300 gallons/day (4 individuals
75 gpcd). Required minimum fire suppression demand is 2500 gallons. Total
)table and fire suppression volume required is estimated to be 400 gallons.
Tater supply appear adequate with 4000 gallons of storage with refills
:heduled at 5 -day intervals. Dry hydrants observed on water tank.
ACCESS DESCRIPTION:
FROM THE INTERSECTION OF THE 1-70 FRONTAGE ROAD AND COUNTY ROAD 215 AT PARACHUTE, PROCEED IN A
NORTHWESTERLY DIRECTION ALONG COUNTY ROAD 215 t2.1 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD,
PROCEED LEFT IN A SOUTHWEST TO NORTHWESTERLY DIRECTION ±1.7 MILES TO A THREE-WAY INTERSECTION,
PROCEED LEFT IN A SOUTHWESTERLY DIRECTION t1.8 MILES TO THE EXISTING MV 16-9 LOCATION, AS SHOWN HEREON.
Section 8
T. 7 S., R 93 W.
ray �
YiACC1
,ti 1 r
I l
o toad 2000
GRAPHIC SCALE IN FEET
11NCH= 2000 FEET
ACCESS DESCRIPTION:
FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 323 (RULISON ROAD) NORTH OF RULISON, PROCEED
SOUTHERLY ALONG COUNTY ROAD 323 (RULISON ROAD) t1.1 MILES TO THE INTERSECTION WITH COUNTY ROAD 309 (RULISON
PARACHUTE ROAD), PROCEED LEFT IN AN EASTERLY DIRECTION t2.3 MILES TO THE INTERSECTION WITH COUNTY ROAD 320
€ (RIFLE RULISON ROAD), PROCEED RIGHT IN AN EASTERLY DIRECTION t6.2 MILES TO THE INTERSECTION WITH COUNTY ROAD
317 (BEAVER CREEK ROAD), PROCEED RIGHT IN A SOUTHERLY DIRECTION s3.6 MILES TO AN INTERSECTION WITH A
DIRT/GRAVEL ROAD, PROCEED LEFT IN AN EASTERLY TO NORTHEASTERLY DIRECTION ±2.7 MILES TO AN INTERSECTION WITH A
DIRT/GRAVEL ROAD, PROCEED RIGHT IN A SOUTHRLY DIRECTION t0.2 MILES TO THE RU 21-6 DRILL PAD LOCATION, AS SHOWN
HEREON.
Construction Plan Prepared for:
I Ir. ,,,
136 Lost Third Street SCALL. 1'•-2000, i� - WPX Energy Rocky Mountain, LLC
Rifle, Colomdo 81650 DATE: 10115114
P1z t970J 625-2720 - 0I , PLAT. 5 of
v�xte70/62s-277s PROJECT,:yaneu RU21-8Dr[llPad- Plat
WIT: ms ACCESS ROAD & TOPO MAP
section 8
/ :03 ,
T. 7S, R. 93 W.T#2 / F0.1
F3.1 //
F
/ r#4
/ C 3.4
T#1
C/7
/ proposed , / ,' /
r' /VOC Unff°-
Proposed ' ,' / / aRAPHIG 86ALE IN FEET
l
Acce7 oad / 2,' r' o //' iINCH=100FEET
op 6' Edge of
/Proposed Pod'
Dayiighf Line ' / ,, /�' po�'aN �2\
Cot%FillL' y� 6� �Cp
1p
/ /OY �
5
d(0� / �g �' / ,' ,/ COY`" 46• / o
ad,/
' .p 06
65th
,yam #� Q�5 F01 / aq.o q �v
ty�tallJa�lab4fraoOgRL9iv'�
W RLL
p
/
ESTIMATED EARTHWORK QUANTITIES (cy)
ITEM
CUT
FILL
TOPSOIL
EXCESS
PAD
23950
16940
7500
-490
PIT
19300
PLAT:
2 of 7
19300
TOTALS
43250
16940
7500
18810
Daylight, me
•NOTE:
1-) Topsoil Volume Based on 12" Soil Depth.
2-) 10% Swell Factor Applied to Earthwork Cut Volume.
3.) Total Disturbed Area =±7,74 ac.
REVISED., 6%2115 Construction Plan Prepared for:
SCALE:
^=100'
WPXENERGY.WPXEner Rock Mountain, LLC
9Y Y
136 Lase rModo Stroot
Rifle, Colorado 81650 %
DATE:
10/75/14
Ph. (970) 625-2720
Fax(970) 625-2773
PLAT:
2 of 7
RU214 Drill Pad - Plat 2
,
PROJECT.:
Valley
DPT.'
etas
CONSTRUCTIONLAYOUT
WPXENERGY VVPXENERGY ROCKY MOUNTAIN, LLC
--Im�IF' POBOX 21858
TULSA, OK 74121'1358
COMPANY NUMBER: 3057
CHECK NUMBER: 3057801644
PAY DATE
SUPPLIER NO.
i SUPPLIER NAME
CHEC
I MaY5,2016
527487
GARFIELD COUNTY BUILDING & PLANNING
$125.00
Invoice Date
Invoice/ Credit Memo
Invoice Descripflon
Gross
Discount
Net
M&Y3,2016
Inv Num: 03 -MAY -2016
Inv Dose: OWTS & STEH PERMIT FEE MV 16-9 PAD
$126.00
$0.00
$125.00
Supplier Support 1-866-581-4981
Page Totals
$0.00
$125.00
WPXENERGY mFr«xENER8Y ROCKY K4O6NTA|N'LbC','\ Y �'
1WWI, POBOX 21358
TULSA, [X<74121'1858 ' `
ConnPonyNonobec3V57 . ..`
� ero
Pay To The Order Of
GARP|ELDCOUNTY BUILDING &PLANNING
ATTN:BROOKE VVBN|N8
1D88TH ST, STE4U1
GLENVVOODSPRINGS, CO810O1 US
OR GRADUALLY FROM TOP TO BOTTOM,
Check Number: 3'6573bf644
Check Date: May 5, 2016
Aulhurimd Signature
1"3[)S93[]4 G L, L,nn x:(]? L 9 2 3 2 2 En: [][][]9 206 5[)0n