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v <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Exxon Company, U.S.A. <br />M-1980-047 <br />Colony Shale Oil Pro <br />November 1, 2003 <br />$550.00 (Due on or before your anniversary date) <br />Garfield <br />~~C~ 6 ~'r~~; <br />ocr 3 f 2003 <br />Division at Minerals and Gec'r <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-216, 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_to_affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal rennet and annual re~nrt ma~tn this form. Please note that on <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 Contact: Brent D. Patterson <br />Permittee Name: Exxon Company, U.S.A. <br />Address: C/O Exxon Mobil Corporation <br />P.O. Box 2567 <br />Houston, TX 77252-2567 <br />FxxON I~o~l` (_or~ora-clod <br />-PhoneNumber:-(28"1)-423-6248 C'L-81~-GS'f-~-G2~-8 --- <br />Fax Number: (281) 423-6392 ~z$7 G f4 - G'39 Z <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 />~ o~zf~o7 <br />Date <br />M iPERMI7~MASTERD000MENTS/M-AF-02. DOC <br />