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Pc --k- JD_1W1rr <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Exxon Mobil Corporation V IBM [a. <br />PERMIT NO.: M-1980-047 <br />OPERATION NAME: Colony Shale Oil Pro ?- OCT 2 6 2009 <br />ANNIVERSARY DATE: November 1, 2009 Li7 L)ivifim of RecWmaffon, <br />Mrfg and Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <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 <br />-- - -operator shall submit-the annual fee, a report-and map showing the extent of current distur-ban-ces-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 may 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 durine the previous year and no <br />new chanL7es to the previous year's map are necessary, then no new map is required, 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: <br />To nn, L. ? &-nn,S <br />Permittee Name: Exxon Mobil Corporation <br />Address: P.O. Box 2567 <br />Houston, TX 77252-2567 <br />Phone Number: (28-1) 6-54-61-83- <br />Fax Number: (281) 654-6392 <br /><ag tl 6 s tf - G D:4 <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 />A. <br />Signature of Corporate Officer, Owner, or Designee <br />John c? <br />Date <br />M: \PERMITIMASTERDOCUMENTS/M-AF-02.DOC