2004-11-01_REPORT - M1980047

• Permit No: M1980047
• IBM Index Class Name: Report
• Doc Date: 11/1/2004
• Doc Name: Annual Fee/Report/Map
• From: Exxon Mobile Corporation
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Exxon Company, U.S.A.
M-1980-047
Colony Shale Oil Pro
November 1, 2004
$550.00 (Due on ar before your anniversary date)
Garfield
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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 year, 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 your revised written annnal report and annnal report ma= 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: Brent D. Patterson
PermitteeName: Exxon Company, U.S.A. tx'xovt Mob'~l Gurpor-.~lo~
Address: C/o Exxon Mobil Corporation
P. O. Box 2567
Houston, TX 77252-2567
Phone Number: [phone]
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.
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Signature of Corporate Officer, Owner, or Designee
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Date --T
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