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Asphalt Specialties Co., Inc. <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1983176 <br />111111111 <br />Receipt #: <br />Date: <br />Permit: <br />16456 <br />11/29/2013 <br />M1983176 <br />F27692 kja 4300 -01 Minerals Annual Fees $791.00 <br />M1983-176 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />