2017-09-29_REPORT - M1980047

• Permit No: M1980047
• IBM Index Class Name: Report
• Doc Date: 9/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Exxon Mobil Corporation
• Annual Report Year: 2017
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:

Permittee Contact:

Paul Caponigro
Permittee Company:

Exxon Mobil Corporation
Address:

Wellness 3, 2B.481
22777 Springwoods Village Pkwy
Spring, TX 77389

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact:

Tom L. Adams
Company:

Exxon Mobil Corporation
Address:

22777 Springwoods Village
Parkway
Bldg W3 Room 2B.481
Spring, TX 77389

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact:

Bret Berta
Company:

Exxon Mobil Corporation
Address:

Newpark Mats
, 00000

Phone Number:

Fax Number:
Email Address: [e-mail]

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-02