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MATERIAL SOURCE APPROVAL REQUEST - DOT …

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MATERIAL SOURCE APPROVAL REQUEST north dakota department of transportation , Environmental and transportation Services SFN 58466 (8-2016)Complete a separate form for each MATERIAL SOURCE location. The following information is REQUIRED (including map file showing boundary of area to be SubmittedPit ID (NDDOT Use Only)Check One: New Existing Expansion of Existing SiteCheck One: Contractor Optioned department optionedLegal DescriptionCountySectionTownship NumberRangeSite Legal Location (quarter section)Approximate Depth of ExcavationSource NameMaterial/Activity (Check all that apply) Aggregate Staging Area or Plant Site Borrow Stockpile Area Rock Pile/Rip-Rap Waste SiteProject InformationName (Project Engineer, Project Manager or NDDOT Tech SupportDivision/District/Consulting Engineering FirmProject))

MATERIAL SOURCE APPROVAL REQUEST North Dakota Department of Transportation, Environmental and Transportation Services SFN 58466 (8-2016) Complete a separate form for each material source location.

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