2012-10-01_REPORT - M1980047 (2)

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DIVISION OF RECLAMATION, MINING AND SAFETY Department of Natural Resources 1313 Sherman St., Room 215 Denver, Colorado 80203 Phone: (303) 866 -3567 FAX: (303) 832 -8106 October 1, 2012 Tom L. Adams Exxon Mobil Corporation 16825 Norchase Drive, Suite 200 Houston, TX 77060 Colony Shale Oil Project, Permit M- 1980 -047, Annual Fee Invoice and Report Request Mined Land Reclamation t'I.l,1til ItI,AI) ('A1 ITI II.i 1' A(' I'I()N la'Ql Please attach out (:O111PI. ':'Ii l) written Ania.tal Itepurt a_litl , Annual llepott I\1 , to this forin Under the terms of your NOI or Reclamation Permit and Colorado Statutes, you must submit Annual Fees and Annual Reports (including a map). You must pay the Annual Fee and submit an Annual Report each year until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was inactive. The Annual Report and Fee requirement will be considered submitted when we have received the following components: 1. APPROPRIATE ANNUAL FEE 2. COMPLETED ANNUAL REPORT 3. ASSOCIATED MAP as required by rule Division records indicate the $633.00 fee is due for the following: Permit: M -1980 -047 Operation Name: Colony Shale Oil Project Anniversary Date: November 1, 2012 Total Fee Due: $633.00 (Due on or before your Anniversary Date) STATE OF COLORADO 11 1111 ANNIIAI FEE SIIRNII I l Al S ARE NO] RECEIVED ON OR BEFORE YOUR ANNIVERSARY DA I I 'I I IF I- N} ORCFMI N I PROCESS WIl I AUTOMAT l('AI I \ Rl INIATIEO I NI OR('FMEN'l A('TION 1- \Y RESITI '1 IN ('IVII PENAL. - 1115 AND/OR RF\ OCA I ION OF YOUR COLORADO D I V I S I O N O F RECLAMATION MINING — &— SAFETY John W. Hickenlooper Governor Mike King Executive Director Loretta E. Pineda Director If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety (the "Division ") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit an Annual Report for that year. Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY ORDER made payable to: Division of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver, CO 80203. If your records indicate these documents and fees have already been submitted, please notify the Division. If you have additional comments and /or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. If you have any questions, please feel free to contact Jim Dupler (303)866 -3567 x8119 or Christine Brookshire (303)866- 3567 x8132. Thank you for your cooperation in this matter. Office of Office of Denver • Grand Junction • Durango Active and Inactive Mines