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0 ;RPT AL FEE and REPORT REQUEST <br />n Mobil Corporation <br />PERMITTEE NAME: PZX10980-047 <br />PERMIT NO.: OPERATION NAME: Colony Shale Oil Pro <br />ANNIVERSARY DATE: November 1, 2008 <br />ECF, ' <br />Division 6 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <br />According to C.R.S. 34732.5-116 or C.R.S. 34-32-116, 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 your revised written annual report and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred durint the previous year and no <br />new changes to the previous vear's map are necessarv. then no new man is reauired. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ronald M. Smith <br />Permittee Name: Exxon Mobil Corporation <br />Address: P.O. Box 2567 <br />Houston, TX 77252-2567 <br />Phone Number: (281) 654-6183 <br />Fax Number: (281) 654-6392 <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 />.? Ge1,a-vY 1`uRS2Vjrv2 <br />Signature o Corporate Officer, Owner, or Designee <br />/0 22 D8 <br />Date <br />CD c:?-- <br />jrm <br />M:\PERMITWMTERDOCUMENTS/M-AF-02.DOC