2017-04-14_REPORT - M1987171

• Permit No: M1987171
• IBM Index Class Name: REPORT
• Doc Date: 4/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Kiewit Western Company
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Daniel Leone
'Do-n is i Lrec ne-
Permittee Company: Kiewit Western Company
Address: 3527 Wabash Street
Colorado Springs, CO 80906
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Roland Obeying
Company: Obering, Wurth&Associates
Address: 1015 Elkton Drive
Colorado Springs, CO 80907
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Tony Collins
Company: Kiewit Western Company
Address: 7926 S Platte Canyon Rd
Littleton, CO 80128
Phone Number: [phone]
Fax Number: [phone]
Email Address:
1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01