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ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Chevron Shale Oil Company, a division of Chevron USA, Inc. <br />PERMIT NO.: ? M-2006-039 RECEIVED <br />OPERATION NAME:: North Clear Creek Construction Materials Mine <br />L/-- NO'J'? 02010 <br />ANNIVERSARY DATE: December 8, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) / Division of RmjS @Uffl, <br />Mining & fnf4?( <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 vour revised written annual report and annual report may 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 disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new may 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: Julie Justus <br />Permittee Name: Chevron Shale Oil Company, a division of Chevron USA, Inc. <br />Address: 760 Horizon Drive Suite 412 <br />Grand Junction, CO 81506 <br />Phone Number: (970) 257-6042 <br />Fax Number: (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 />;4_1 <br />lb A, Si tore of Cot orate Officer, Owner, or Designee <br />/l L1,5110 <br />Date