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,. •, <br />~_ <br />Permittee Name: <br />Permit No: <br />_.: Operation Name: <br />_, Anniversary Date <br /> <br />Exxon Co USA <br />M-80-047 <br />Colony Shale Oil PRO <br />11/01/87 <br />~~~ I~~I~~~~~~I~~I~~ <br />{~ 111/112 Enciosure <br />A'~~~k%-~ ~?3 ~~ <br />DEC 31981 <br />1JIINED LAND <br />RECLAMATION DIVISION <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />/ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: 5EE ~-rT/}cµE'D ~-E?T~Q <br />(Rev. 02/87) <br />5257E <br />W" <br />c~ <br />