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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Exxon Company, U.S.A. <br />M-1980-047 <br />RECEIVED <br />OCT 3 0 2002 <br />Colony Shale Oil Pro <br />November 1, 2002 <br />Division of Minerals and Geology <br />$550.00 (Due on or before your anniversary date) <br />Garfield <br />According [o 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 [o affected <br />land, reclamation accomplished to date and during the_preceding_yeaz._new disturbances_that-are anticipated to <br />occur during the upcoming year, reclamation that will be performed during [he coming year, the dates for [he <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual resort map to this form. Please note that an <br />adequately Labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information Please verify and make any necessary <br />changes: <br />Permittee Con[act: Brent D. Patterson <br />Permittee Name: Exxon Company, U.S.A. Fxxoln Mobll Gor ~oro~'Ipy <br />Address: C/O Exxon Mobil Corporation <br />P.O. Box 2567 <br />Houston, TX 77252-2567 <br />Phone Number: (281)423-6248 ~2Y1~ 6S~f - 6248 <br />Fax Number: (281) 423-6392 Cz8 t) G,5'4~ - G 39'L <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 <br />enclosed. <br />~~~ ,~ ~_ <br />Signature of Corporate Officer, Owner, or Designee <br />fo/ -s,0 2- <br />Da[e <br />M:IPERMITNIASTERD000M ENTS/M-AF-02. DOC <br />