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• • III IIIIII III IIII III � <br /> 999 <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> PERMITTEE NAME: Exxon Company,U.S.A. NOV 0 12000 <br /> PERMIT NO.: M-1980-047 <br /> Division of Minerals and Geology <br /> OPERATION NAME: Colony Shale Oil Pro <br /> ANNIVERSARY DATE: November 1,2000 <br /> ANNUAL FEE DUE: $550.00(Due on or before your anniversary date) <br /> COUNTY: Garfield <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br /> operator shall submit the annual fee,a report and map showing the extent of current disturbances to affected land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br /> during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br /> of active operations, and the date active operations ceased for the year, if any. <br /> Please attach Your revised written annual report and annual report may to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suf`iae for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Brent D. Patterson <br /> Permittee Name: Exxon Company, U.S.A. e x x o w tAo b;1 Go��orat'oK <br /> Address: P.O. Box 2567 <br /> CF.PR.address_2 <br /> Houston, TX 77252-2567 <br /> Phone Number: 2814236248 <br /> Fax Number: 2814236392 <br /> If you have additional comments and/or information that should be provided to the Division, please provide it <br /> below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br /> Signature of Corporate Officer or Owner <br /> is/�i/2aoo <br /> Date <br />