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*- Q?r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: /FXTO Energy Inc. <br />PERMIT NO.: / M-2000-073 / JUN 0 4 2010 <br />OPERATION NAME: Shults Gravel Pit V ®lvlgion 01 Reclama"n, <br />mining & Sa?e? <br />ANNIVERSARY DATE: June 27, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <br />,-According to C.R.S: 3.4_32.5-1.1.6 or-C.R.S. 34-32-1-1-6, 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 map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances 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: Kelly Small <br />Permittee Name: XTO Energy Inc. <br />Address: 382 Road 3100 <br />as a C) S <br />Aztec, NM 87410 ^ <br />Phone Number: CF.PR.telephone_number <br />Fax Number: <br />505 - 333-??IOC? <br />505- a? - o??'?? <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 />i ature f orporate Officer, Owner, or Designee <br />619 (in <br />Date <br />M: \PERMITIMAS TERDOCUMfiNTS1M-AF-04