2005-10-24_REPORT - M1980047

• Permit No: M1980047
• IBM Index Class Name: Report
• Doc Date: 10/24/2005
• Doc Name: Annual Fee/Report/Map
• From: Exxon Mobil Corporation
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMTI' NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~d ~ r
A,N~fNiiAi. FF.F, and REPORT RF.OiiF.ST
'Exxon Mobile Corporation
r/I1~I-1980-047
Colony Shale Oil Pro
November 1, 2005
~b M
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ACCT 2 ~ 2C05

$550.00 (Due on or before your anniversary date)
Garfield
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
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
-- - --land-reclamation-accomplished-to-date-and-during-the-preceding ear-new-disturbances-that-are-anticipated-to--- --
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ymn• revised written anm~al repnrf and annual re~nrt map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: /~
Permittee Contact: Etr~ /~ dNA~.D /~ . f.~ ~7r-
Permittee Name: Exxon Mobil Corporation ~jp~~.Qij m ~i~ C®.Q/~o.e,t-f.~
Address: r"^ F n,r^~.'' r ^~^.:°
r
P. O. Box 2567
Houston, TX 77252-2567
Phone Number: [phone] Z ~, /- 6 $y ~/ $ 3
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporal fi er, Owner, or Designee
J~ ! 3~° s
Date
M:~PERMIT4MASTERDOCUMENTS/1N-AF-02. DOC