2005-03-28_REPORT - M1977424

• Permit No: M1977424
• IBM Index Class Name: REPORT
• Doc Date: 3/28/2005
• Doc Name: Annual Fee/Report/Map
• From: Occidental Oil Shale Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Occidental Oil Shale, Inc.
M-1977-424
Logan Wash
March 28, 2005
RECEIVED
tAAR 2 8 2005
Division of Minerals and Geology
$550.00 (Due on or before your anniversary date)
Gartield
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
- land, reclamatiorraccomplished`to date and during"the preceding year, new disturbances-that aze anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written annnal report and anmral re nn rf maTtn this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Franklin Miller
Permittee Name: Occidental Oil Shale, Inc.
Address: C/o Glenn Springs Holdings, Inc.
2480 Fortune Dr., Ste, 300
Lexington, KY 40509
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
~~
Signature of Corporate Officer, Owner, or Designee
~~S~b~
Date ~
M:~PERMI7'~MASTERDOCUMENTS/M-AF-02.DOC