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i <br />~ III IIIIIIIIIIIIIIII <br />112 Attachment <br />Permittee Name: Exxon Cer~ratinn <br />Operation Name: Colony Shale Oil Project <br />Permit No: Rn-a7 <br />Anniversary Date: Nnvamhor ~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />IX I Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I-I Annual Report <br />I_I Map <br />Remarks: The Colonv Shale Oil Proiect's annual report will be submitted <br />prior to December 31, 1985. <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />