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~W <br />ANNi1Ai. FF,F, and RF.PnRT RF.niTFST ~ ~ ~ ~,, <br />PERMITTEE NAME: Kiewit Western Co. ~~1, ~ / L~05 <br />PERMIT NO.: M-1987-171 tliviaian of C9incrab Lh e;c!^C7 <br />OPERATION NAME: Fountain Colony Pit <br />ANNIVERSARY DATE: May 9, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: El Paso <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 anmral rennrt and anmral re~nrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tony Collins <br />Permittee Name: Kiewit Westem Co. <br />Address: 7926 S. Platte Canyon Rd. <br />Littleton, CO 80128 <br />Phone Number: (303} 979-9330 <br />Fax Number: (303) 979-1576 ~ <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 />Signature of Corporate Officer, Owner, or Designee - <br />6 -1-0 <br />Date <br />