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<br /> ~/ <br /> ~~ ~R <br /> ANN AL FEE and REPORT REQUEST <br />PERMfI'1'EE NAME: / EnCana Oil & Gas (USA), Inc. <br />PERMIT NO.: ~,YI-2005-069 <br />/ <br />OPERATION NAME: West Fork Pit <br />ANNIVERSARY DATE: October 13, 2007 <br />ANN[JAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <br />RECE,VEp <br />~~ ~ 5 2007 <br />~~vM to n of Reo/amatiort, <br />9 and Safah, <br />According to C.R.S. 34-32.5-t 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that wilt be perfonncd during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised writtep annual report and annual renort map to this form. The Apnua- Report <br />& Fee requirement is not met until we have received the following components: fee, renort, and associated <br />man. [f no new disturbances or reclamation have occurred during the previous veer and no new chances to <br />the previous year's man are necessary. then no new man is reauired. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates m:d includes the <br />above elements may since for a written report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Daniel Zwierzchowski <br /> 'rfGS ~o/\ t~c15o~ <br />Pennittee Name: EnCana Oil & Gas (USA), Inc. <br />Address: 2717 County [toad 215, Suite 100 <br /> Parachute, CO 81635 <br />Phone Number: (970)285-2689 C,g7o~ z~S-~'~`~ <br />Fax Number: (970) 285.2691 <br />If you have additional comments andJor 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. Annua] Report instmctions are enclosed. <br />~~~~ <br />Signature uCCurpurate Officer, Owner, or Designee <br />~e_.e T. 2`$~ "2007 <br />Date <br />