HomeMy WebLinkAbout20072064.tiff SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL
REVIEW (USR) APPLICATION
FOR PLANNING DEPARTMENT USE DATE RECEIVED:
RECEIPT#/AMOUNT# /$ CASE#ASSIGNED:
APPLICATION RECEIVED BY PLANNER ASSIGNED:
Parcel Number: 121324300002
Legal Description: S2SE4 of Section 24, Township 3N, Range 65W
Flood Plain: None Zone District:Agricultural (A) Total Acreage:80 Acreage for USR: 80
Overlay District: None Geological Hazard: None
FEE OWNER(S) OF THE PROPERTY:
Name: Russell L. Gurtler Jr. Family Trust and Dorthy K. Gurtler Trust
Address: 7538 Weld County Road 49, Hudson, CO 80642
APPLICANT:
Name: SemCrude, L.P. c/o Glenn Collum Phone: 405-692-5120
Address: 11501 South 1-44 Service Road, Oklahoma City, OK 73173-8315
AUTHORIZED AGENT (See Below:Authorization must accompany applications signed by Authorized Agent)
Name: Lauren Light, Tetra Tech
Address: 1900 S. Sunset Street, Suite 1-F Longmont, CO 80501
Phone 303-772-5282 Email: Lauren.Light@ttrmc.com
PROPOSED USE: Crude oil unloading and storage facility in the A(Agricultural)Zone District. Section 23-3-40.A.1
of the Weld County Code allows oil and gas storage facilities as a Use by Special Review in the A(Agricultural)Zone
District.
I (We)hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with
or contained within the application are true and correct to the best of my(our)knowledge. Signatures of all fee owners
of property must sign this application. If an Authorized Agent signs, a letter of authorization from all fee owners must
be included with the application. If a corporation is the fee owner, notarized evidence must be included indicating that
the signatory has to legal authority to sign for the corporation. \ I -7 e4ccli siAr
Signature: Owner or Authorized Agen Date
2007-2064
March 15, 2007
Weld County Planning Department
918 10th Street
Greeley, CO 80631
To Whom It May Concern:
SemCrude L.P. has contracted with Tetra Tech to process all work related
to a Site Specific Development Plan and Use By Special Review (USR) application to be
filed in Weld County. Tetra Tech is authorized to represent SemCrude L.P. throughout
this process. Peter L. Schwiering is authorized to sign for SemCrude L.P. per the attached
documentation.
Sincerely,
lk, 1 A 3—/s — o7
Peter L. Schwiering Date
President
SemCrude L.P.
EXHIBIT
1a
March 27, 2007
Weld County Planning Department
918 10`h Street
Greeley, CO 80631
To Whom It May Concern:
The Russell L. Gurtler Jr. Family Trust and Dorthy K. Gurtler Trust authorize SemCrude
L.P. to apply for a Use by Special Review(USR) on the property described in the
attached contract. Russell L. Gurtler Jr. Family Trust and Dorthy K. Gurtler Trust
authorize the buyer to take any steps necessary to acquire the USR permit and also grants
such authorization to any agents, representatives, consultants or contractors hired by
SemCrude L.P. to facilitate processing of the USR. Dorthy K. Gurtler is authorized to
sign for the Trust per the attached documentation.
Sincerely,
rrEA �;' �� �-� 3/,2 g/o 7
Dorthy K.Gurtler Date
i Page 1 of 1
Lauren Light
From: Collum, Glenn [gcollum@SEMGROUPLP.COM]
Sent: Wednesday,April 18, 2007 9:55 AM
To: Lauren Light
Cc: Davis, Gary
Subject: FW: Fire Contingency Plan Platteville Facility
Attachments: SemCrude Tank Fire Contingencey Platteville final 4-18-2007.doc
Please find attached the Fire Contingency Plan for your review and submittal. If you have any questions feel free
to give me a call.
Thanks,
Glenn
Venn &ileum.
SemCrude, LP
Manager Environmental and R-O-W
(405)692-5120 Office
(405)642-3874 Cell
gcollum@semgrouplp.com
From: Davis, Gary
Sent: Wednesday,April 18, 2007 10:40 AM
To: Collum, Glenn
.-- Cc: Coen, Edith
Subject: Fire Contingency Plan Platteville Facility
Glen,
Attached is the final fire contingency plan for the planned Platteville Facility. I sent a copy of the plan to Randy
Macy the local fire chief of the La Salle Fire Department. We had a phone conversation following his review of
the plan and he stated there are no additional local requirements needed in the plan.
Gary Davis
40,
4/18/2007
Platteville,Colorado Facility SemCrude
Telephone:
Fax:
FIRE CONTINGENCY PLAN
SemCrude Platteville Terminal/Storage/Pump Station Facility
PHYSICAL ADDRESS:
South Half SE Quarter Sec. 24 3N 65W Weld County, Colorado
GENERAL INFORMATION:
SemCrude Platteville facility consist of tank storage,truck unloading stations and a pump
station. The crude oil product is brought in the facility by truck and shipped out by
pipeline.
TANK FIRE
1. In the event of a tank fire dial 911 on the nearest phone. Give the dispatcher
receiving the call the following information.
• The exact address of the terminal and the location the tank fire is occurring. The
tank# and what product is stored in the tank. A list of all tanks is on page 2.
• Total capacity of the tank, diameter and the current liquid level of the tank.
• What type of tank is on fire(fixed cone roof with internal floater).
2. Call 1-800-522-3883 and inform the SemCrude SCADA operator located in
Oklahoma City of the situation and provide the same information.
3. The SCADA operator will notify SemCrude senior management personnel located
in Oklahoma City of the situation.
4. Notify the terminal manager if he is not on site or aware of the situation.
5. A head count should be conducted to ensure that all personnel and contractors are
accounted for.
6. If an employee or contractor is missing during the head count, this information
should be passed on to emergency services.
7. All non essential personnel including contractors are to be sent home.
8. At any time during the tank fire the local fire department (La Salle Fire
Department) can no longer assure that they can control and or extinguish the fire,
the terminal manager or VP of operations will notify Williams Fire and Hazard
Control (contact information page 2).
1 of 4
4/18/2007
PLATTEVILLE TANK STORAGE
5,000 bbls. 30 ft Diameter Fixed Cone Roof Internal Floating
5,000 bbls. 30 ft Diameter Fixed Cone Roof Internal Floating
5,000 bbls. 30 ft Diameter Fixed Cone Roof Internal Floating
5,000 bbls. 30 ft Diameter Fixed Cone Roof Internal Floating
5,000 bbls. 30 ft Diameter Fixed Cone
Roof Internal Floating
5,000 bbls. 30 ft Diameter Fixed Cone
Roof Internal Floating
100,000 bbls. 122 ft Diameter Fixed Cone Roof Internal Floating
PLATTEVILLE TRUCK UNLOADING/PUMP STATIONS
12-Truck Unloading Stations
1- Pump Station
LOCAL EMERGENCY RESPONDERS: Dial 911
POLICE
FIRE and EMS
HOSPITAL
COUNTY SHERIFF
HIGHWAY PATROL
CONTRACT EMERGENCY RESPONDERS:
Williams Fire & Hazard Control
800-231-4613
409-745-3021 Fax
24-Hour Emergency Numbers:
409-727-2347 or 281-999-0276
SEMCRUDE PERSONNEL:
Position Open Pete Schwiering Gary Davis
Terminal Manager VP of Operations Manager Health & Safety
918-225-1914 ext#10 405-692-5104 Office 405-692-5147 Office
405-659-3828 Cell 405-760-1134 Cell 405-760-9973 Cell
918-225-4750 Home 405-733-5388 Home
2 of 4
4/18/2007
Page 1 of 2
r� ^
Michelle Martin
From: Light, Lauren [lauren.light@ttrmc.com]
Sent: Wednesday, June 06, 2007 3:02 PM
To: Michelle Martin
Subject: RE: USR-1614 aka semcrude
I just spoke with Glenn Collum from SemCrude and they would like the hours of operation changed to 24 hours a
day, 7 days a week. They were only planning on a chain link fence around the facility as even if they added slats
or fabric it would not screen the tanks. The facility is set back quite a ways from WCR 49 which is the busiest
road and screening would not affect the view from the road.
Do I need to send you a separate document stating the hours and days of operation or will this email suffice?
Thanks.
Lauren Light I Project Manager/Senior Planner
Main:303.772,5282 Fax:303.772,7039
lauren-light@ttrmacom
Tetra Tech i Infrastructure Group
1900 South Sunset Street,Suite 1-F 1 Longmont,GO 80501 www.tetratech.com
'LEASE NOTE This message,including any attachments may include privileged,confidential a.iron inside intern iation,Any distribution
use of this communication by anyone other than the intended redpio t s shinty prohibited and may he unlawful If you ore not the intended
reciplemt,ale a.r rx;Gfy the sender by replying to this message and then delete it from your system.
From: Michelle Martin [mailto:mmartin@co.weld.co.us]
Sent: Wednesday, June 06, 2007 7:37 AM
To: Light, Lauren
Subject: RE: USR-1614 aka semcrude
Good Morning Lauren,
Yes you are more then welcome to come in and view the file for USR-1614, any copies you wish to
make will cost $1.25 a page. Could you please clarify the hours of operation, The application states it
will be open 6 days a week 14 hours a day; which days of the week and what hours of the day. Also the
plan states there will be a chain link fence that surrounds the operation is there any plastic slats or fabric
proposed for the fence? Thanks again for your assistance in the above questions. I will have a better
understanding early next week if the case will go consent.
Belle
Planner II
4209 CR 24.5
Longmont, CO 80504
mmartin@co.weld.co.us
PHONE: (720)652-4210 x 8730
FAX: (720) 652-4211
From: Light, Lauren [mailto:lauren.light@ttrmc.com]
Sent: Tuesday, June 05, 2007 4:44 PM
To: Michelle Martin
Subject: USR-1614 aka semcrude
06/07/2007
Page 2 of 2
Julie Cozad will be coming by on Wednesday so would it be o.k. for her to pick up any referrals and adjacent
property owner letters for semcrude that I don't already have? I have public works, school district, sheriff's office
and state engineer. Is there anything I need to get to you before PC? Can we go consent? You're the
bestlllllllllilllllllllllllllllillu
Lauren Light I Project Manager/Senior Planner
Main:303.772.5282 I Fax: 303.772.7039
lauren.light@ttrnc.com
Tetra Tech i infrastructure Group
1900 South Sunset Street, Suite 1-F(Longmont.CO 80501 www.tetratech.com
PLEASE NOTE. This message,including any attachments,may include privileged,confidential vial and/or inside information.Any distribution Or
use of this communication by anyone other than the intended recipient is strictly prohibited and may be unlawful. f you are not the intended
recipient,please notify the sender by rep ying to this message and then delete it from your system.
06/07/2007
SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL
REVIEW (USR) QUESTIONNAIRE
The following questions are to be answered and submitted as part of the USR application. If a question does not
pertain to your use, please respond with"not applicable",with an explanation as to why the question is not applicable.
1. Explain, in detail, the proposed use of the property.
The property will be utilized for a crude oil truck unloading facility, as well as a crude oil tank farm. Trucked
crude volume is initially anticipated at approximately 20,000 barrels per day and will be transported from
surrounding local production fields. Terminal crude volume taken into the tank farm will be predominantly
sourced from existing wells in Colorado. Assets on the ground will consist of 12 truck unloading bays, 1 large
tank (100,000 bbls)with 4 future tanks (100,000 bbls), 4 small tanks (5,000 bbls)with 4 future tanks (5,000
bbls), several pumps, valves, &associated piping. A new office will be constructed on-site as well.
2. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 22(Comprehensive
Plan).
Section 22-5-90—Oil and gas development in the County is an integral part of the county economy, and has a
substantial direct and indirect impact on current and future land use. Oil and gas development is cyclical but the
economics of drilling has caused extensive drilling activities in the County.
Although this request is not for oil drilling it is an essential part of oil development in the County as well as
the Nation. SemCrude L.P. has 6.5 million barrels of storage capacity in Oklahoma, Kansas, Texas and
Louisiana and 541,000 barrels of crude oil and condensate per day are purchased, transported, gathered
and/or sold in the United States.
Section 22-5-100.A 4.OG.Policy 1.4 — The County will seek the imposition of protective measures through
available state, county and federal regulations to ensure that the mineral operator conducts operations in a
manner which will minimize current and future environmental impacts.
Section 22-2-60.G A.Goal.7 — Protect agricultural uses from those uses which hinder the operations of the
agricultural enterprises.
The SemCrude facility will not hinder the operation of agricultural uses. The site was bought from the Trust that
will continue to own and farm the adjacent property to the west and north.
SemCrude L.P. will adhere to any and all applicable state, county and federal regulations.
This proposal is consistent with the Comprehensive Plan as described in the goals and policies outlined above.
3. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 23(Zoning)and the
zone district in which it is located.
The proposed use is consistent with the intent of the A(Agricultural)Zone District. Section 23-3-40.A.1 of the
Weld County Code states: "Mineral resource development facilities including, oil and gas storage facilities."
Section 23-1-90 defines an oil and gas storage facility as: "One(1)or more tanks which receive and store oil or
gas from sources other than direct from the oil and gas well" There will be no processing on this property and
the oil will go directly into an oil line which transfers the oil to a refinery in Oklahoma. The proposed facility
adheres to the sections noted above which is consistent with the intent of the agricultural zone district.
4. What types of uses surround the site? Explain how the proposed use is consistent and compatible with
surrounding land uses.
East— Pasture - no structures
West— Pasture- no structures
North— Pasture - no structures
South —Crops - no structures
The proposed use is consistent and compatible with surrounding land uses,which are comprised primarily of
pasture land and irrigated farmland.
5. Describe, in detail, the following:
a. How many people will use this site?
There will be up to sixteen (16) people per hour utilizing the site to drop off crude oil. There will be
three(3)employee(s) at the office.
b. How many employees are proposed to be employed at this site?
Three (3)employee(s)will be onsite.
c. What are the hours of operation?
The business operates six days a week, 14 hours a day.
d. What type and how many structures will be erected (built)on this site?
A two hundred(200')square foot office will be built on the parcel. Various oil equipment is delineated
on the accompanying plat. (Crude oil storage)
e. What type and how many animals, if any, will be on this site?
No animals will be located on the property.
f. What kind (type, size,weight) of vehicles will access this site and how often?
Three (3) employee vehicle(s) will access the site during day light hours. Semi-trucks will deliver
crude oil at an average rate of sixteen (16)vehicles per hour at full build-out.
g. Who will provide fire protection to the site?
La Salle Fire Protection District
h. What is the water source on the property? (Both domestic and irrigation).
A commercial well has been applied for through the State Division of Water Resources.
What is the sewage disposal system on the property? (Existing and proposed).
An individual sewage disposal system will be constructed in accordance with all applicable codes.
j. If storage or warehousing is proposed, what type of items will be stored?
There will be no storage or warehousing on the site other than crude oil.
6. Explain the proposed landscaping for the site. The landscaping shall be separately submitted as a landscape
plan map as part of the application submittal.
A minimal amount of landscaping is proposed, as the operation will be located off of the main road and there
will be semi-trucks entering and leaving the facility. In addition, the soil is very sandy, according to the soil
survey, which is not suitable for most vegetation. Please see attached landscape detail.
r-+
7. Explain any proposed reclamation procedures when termination of the Use by Special Review activity occurs.
Should the facility be permanently discontinued it would be marketed under applicable county planning
and zoning regulations to its greatest and best use.
8. Explain how the storm water drainage will be handled on the site.
See attached drainage information.
9. Explain how long it will take to construct this site and when construction and landscaping is scheduled to
begin.
Construction of the facility is anticipated immediately upon approval of this application. It will take
approximately seven(7) months to complete construction. A minimal amount of landscaping is proposed and
it will be completed upon construction of the office.
10. Explain where storage and/or stockpile of wastes will occur on this site.
There will be no waste generated from this site.
11. Additional information.
SemCrude, headquartered in Tulsa, Oklahoma, gathers, stores and markets crude oil and condensates.
The company's strong presence in North America's central energy corridor, sweeping from the Gulf Coast
to Canada, is a reflection of SemCrude's efficient and cost-effective customer services.
SemCrude has offices located in Oklahoma City, Houston, Wichita, Denver and Abilene, Dumas, Texas.
They service more than 21,000 leases and 3,000 operators throughout the Mid-Continent.
SemCrude's Field Services group, located in the Texas Panhandle, is the largest provider of customer
services in the industry. The group's contiguous pipeline systems in Oklahoma and Kansas are integral
providers of refinery supply to Kansas, Texas and Oklahoma's Cushing storage facility.
SemCrude's operations are in Kansas, Oklahoma, Texas and Colorado. The company's assets allow it to
provide efficient and cost-effective customer service.
SemCrude's Assets and Services
Almost 6.5 million barrels of storage capacity in Oklahoma, Kansas, Texas and Colorado.
541,000 barrels of crude oil and condensate per day purchased, transported, gathered and/or sold in the
United States.
More than 2600 miles of pipeline in Oklahoma, Kansas, Texas and Louisiana.
Extensive crude oil and oil field service operations supported by approximately 110 pipeline truck injection
stations, and 296 transport and service vehicles.
Touch Star truck/field hand-held computers that collect accurate and timely volume information and
transmit data electronically to SemCrude's central system.
PRESS RELEASE-SemGroup announces New Pipeline to Link Oklahoma and Colorado
February 9, 2007 Tulsa, Okla.—SemGroup, L.P, announced today that Front Range Pipeline, L.L.C. will
build a crude oil pipeline extending from Colorado's DJ Basin, an area well known for its oil and natural
gas reserves, to Cushing, Oklahoma. The pipeline is expected to be operational by January 2009.
"Front Range will build a 12inch pipeline that is approximately 550 miles in length," said Kevin Foxx,
SemGroup executive vice president and chief operating officer. "The Front Range Pipeline will originate
near Platteville, Colorado, and terminate at SemCrude's Cushing terminal."
SemCrude Pipeline, L.L.C., a wholly owned subsidiary of SemCrude, L.P. which is SemGroup's crude oil
business segment, is the majority owner of Front Range Pipeline. Front Range Pipeline will build and
operate the system, while Kerr McGee Oil &Gas Onshore, L.P. (a subsidiary of Anadarko Petroleum
Corporation (NYSE: APC))and Noble Energy, Inc. (NYSE: NBL)will be anchor shippers on the pipeline.
Foxx said, "Front Range will provide DJ Basin producers direct access into the Cushing market and to
refiners in the MidContinent area. It will help producers have uninterrupted flow capacities and receive
maximum value for their crude oil"
SemCrude owns more than 4.3 million barrels of crude oil storage in Cushing and has additional tanks
under construction there. Cushing is the site of the largest crude oil trading hub in the United States and is
the designated delivery point for New York Mercantile Exchange crude oil futures contracts.
SemCrude, L.P. transports, gathers, stores and markets crude oil in the United States. It owns 2,563 miles
of pipeline and has almost 7 million barrels of storage. For additional information, visit
www.semcrude.com. SemGroup, L.P. is a privately held midstream company providing the energy
industry means to move products from the wellhead to the wholesale marketplace. With assets in the
United States, Canada, Mexico, Wales (United Kingdom)and Switzerland, SemGroup's business
segments focus on activities related to crude oil, refined petroleum products, natural gas, natural gas
liquids and asphalt. Based in Tulsa, Oklahoma, SemGroup is ranked in the top 10 of Forbes magazine's
list of America's Largest Private Companies. To learn more, go to www.semgrouplp.com.
TETRA TECH
April 17, 2007
Drew Scheltinga
Weld County Public Works Division
1111 H Street
Greeley, CO 80632
RE: Semcrude USR Drainage Analysis
Dear Mr. Scheltinga:
This letter is provided to describe the drainage at the proposed Semcrude crude oil
unloading facility. The site is located in the S '/2 of the SE '/a of Section 24, Township 3
North, Range 65 West of the 6th Principal Meridian. It is bound on the South by Weld
County Road (WCR) 30, on the East by WCR 49, and on the West and North by the
Talbot property. The site is 80 Acres in size more or less.
The existing site consists of mainly prairie land and some weeds. There are some existing
storage tanks and gas wells located on site. The site generally drains from northwest to
southeast. On site soil is designated as Olney loamy sand and Vona loamy sand; soil
hydrologic soil group B.
The unloading facility, paved area for the trucks, some storage tanks, spill confinement
berms and a detention pond will be a part of the developed portion of the site. The
developed portion of the site is approximately 24.34 acres is size. The unloading facility
will be located in the central portion of the site. The western and eastern portions of the
site will remain undisturbed. Some offsite flows from the west will enter the site. A swale
will be designed to collect the historic runoff from offsite and the western undisturbed
portion of the site to transport the storm water around the proposed development. Water
quality and detention pond volume will be provided for the developed portion of the site.
Historic runoff coefficients of the site are C5= 0.088, and O100= 0.362. Historic runoff
from the considered portion of the site was calculated to be Q = 4.05cfs, Q100 = 31.98cfs.
After this portion of the site is developed, the new imperviousness of the area will be
17.51%. Proposed runoff coefficients of the site are C5 = 0.185, and C100= 0.430.
Developed site runoff was calculated to be Q = 14.59cfs and Q1oo = 64.89cfs.
The western and eastern portion of the site will remain undeveloped and runoff from
these portions will be released undetained at the respective historic rates. The runoff from
the developed portion of the site will flow into the proposed detention pond. The pond
will be created by the proposed secondary (oil) containment berm located on the eastern
side of the developed portion of the site.
R:A5291001A Documents V Drainage ADrainage LetterALetter final.doc
mit TETRA TECH Page 2
Mr. Drew Scheltinga
April 17, 2007
The outlet from this pond will have a movable gate at the invert, and an overflow weir
upstream of the outlet control. The outlet control will be sized to release at the
predevelopment 5-year runoff rate (4.05 cfs). The weir elevation will be set at an
elevation 6-inches above the oil containment volume. Any water flowing over the weir
will enter a structure through a submerged orifice so any oil would float above the
releasing water. The oil containment volume will be equal to the largest storage tank on
the site. Following a runoff event, the water held in the pond will be inspected for oil
contamination. If the water is clean, the movable gate will be opened to allow the pond
to drain through the outlet control. In addition, the oil storage tanks will have a primary
containment berm around each tank. The outlet from these containment areas will also
have a movable gate, and accumulated water will only be released following inspection.
The retention volume inside the individual containment berms was not considered in
runoff calculation for the site, thus making the calculations more conservative.
If contamination is found in detained water, no water will be released through the
movable gates until removal/remediation of any contamination is completed. This could
include removal of the entire volume of contained water for treatment off site.
Based on Weld County Drainage criteria, we recommend that 3.00 Acre feet storage
volume be included for storm water quality and detention.
Thank you for your consideration. Please call me if you have any questions.
Sincerely,
TETRA TECH 0•DO L/L.s
O0 •c�W �•i(S)
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Ue� 264572);
/ James W. Kaiser, P.E.
Senior Project Manager acs ••
`S'�ONAL
7
WELD COUNTY ROAD ACCESS INFORMATION SHEET
Road File# Date: April 17, 2007
^ E#:
Jther Case#: Weld County Department of Public Works
111 H Street, P.O. Box 758, Greeley, Colorado 80632
Phone: (970)356-4000, Ext. 3750 Fax: (970) 304-6497
1. Applicant Name: SemCrude, L.P. do Glenn Collum Phone: 405-692-5120
Address: 11501 South 1-44 Service Road City Oklahoma City State OK Zip 73173
2. Address or Location of Accessl/4 mile west of the intersection of WCR 49 and WCR 30
Section 24 Township 3N Range 65W Subdivision Block Lot
Weld County Road#: 30 Side of Road north Distance from nearest intersectionNW
corner of WCR 30 and WCR 49
3. Is there an existing access(es) to the property: Yes x No #of Accesses Two
4. Proposed Use:
® Permanent ❑ Residential/Agricultural 0 Industrial
❑ Temporary 0 Subdivision ❑ Commercial ® Other Use-by-Special Review
for a crude oil unloading and storage facility.
___*************,.,_`_********************_**************************************_******************__***************._`_,,****************
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
--O&G = Oil & Gas
,R. = Ditch Road
▪ = House
• = Shed (.f
• - Proposed Access
A - Existing Access
i'G
� •
NT vim o 6R
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
❑ Installation Authorized ❑ Information Insufficient
• eviewed By: Title:
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