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• <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />- ,k?l_ <br />AL FEE and REPORT REQUEST <br />/Kiewit Western Company <br />M-1987-171 <br />Fountain Colony Pit <br />May 9, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />El Paso <br />DYE <br /><AY 0 4 2009 <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_precedmg_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 annual report and annual report map 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 necessarv, then no new map 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: Tiffany Klabo <br />Permittee Name: Kiewit estern Compan <br />Address: 3527 Wabash Street <br />Colorado Springs, CO,-80906 - - - <br />Phone Number: (719) 393-0026 <br />Fax Number: (719) 393-8416 <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 />or Designee <br />Date