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<br />111/112 Enclosure <br />Permittee Name: Exxon Co USA <br />Permit No: M-80-047 <br />RECEIVE <br />Operation Name. Colony Shale Oil PRO ~ E ~ 0 ~ X986 <br />Anniversary Date: 11 / O1 / 86 <br />MINED 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 />x Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: The annual report and mans will be submitted on or <br />before December 20, 1986 as agreed to in prior years. <br />Signature <br />