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<br />PERMITTEE NAME: i/ Chevron Shale Oil Company, a division of Chevron USA, Inc. <br />PERMIT NO.: M-2006-039 RECNWRD <br />OPERATION NAME: North Clear Creek Construction Materials Mine <br />ANNIVERSARY DATE: December 8, 2009 Gov L 5 2009 <br />?Divi"n of Reclamation, <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) Alining and Safety <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 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 <br />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 map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturhances or reclamation have occurred during the previous year and no new changes to <br />the previous vear's map are necessarv. then no new man is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: meow <br />Julie Justus <br />Permittee Name: Chevron Shale Oil Company, a division of Chevron USA, Inc. <br />Address: <br />760 Horizon Drive, Ste. 412 <br />Grand Junction, CO. 81506 <br />Houston, f X 7i099 <br />Phone Number: (281) 561 3684 <br />970-257-6042 <br />Fax Number: 356-8353 970-245-6489 <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 enclosed. <br />- OIX-L ??' <br />Signa of Corporat fcer, Owner, or Designee <br />/I /? o <br />Date