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NF 'k Qfr <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Chevron Shale Oil Company, a division of Chevron USA, Inc. ? <br />PERMIT NO.: M-2006-039 <br />OPERATION NAME: North Clear Creek Construction Materials Mine <br />ANNIVERSARY DATE: December 8, 2008 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) DE? O $ ZO00 <br />COUNTY: Garfield u;v`::ici30Yi, <br />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 <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 will be performed during the coming year, the dates for the beginning of <br />active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. The Annual Report & <br />Fee requirement is not met until we have received the following components: fee, report, and associated map. <br />If no new disturbances or reclamation have occurred during the previous year and no new chances to the <br />urevious vear's map are necessary, then no new may is required, provided that the Operator shall state this <br />in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above <br />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: Mfi&+HTT n <br />Cl uexl-' loreSXW <br />Permittee Name: Chevron Shale Oil Company, a division of Chevron USA, Inc. <br />Address: 11111 South Wilcrest <br />Houston, TX 77099 <br />Phone Number: (281) 561-3687 <br />Fax Number: (888) 356-8353 <br /> <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along wi your written report and map. Annual Report instructions are enclosed. <br />S' ature of Corpora Officer, Owner, or Designee <br />/iZ -"7l-,woe <br />Date