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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004009 <br />Asphalt Specialties Co., Inc. <br />000000000 <br />31181 jwd 1 4300 -MTRO I Minerals Technical Revision <br />M- 2004 -009 <br />Receipt #: 18604 <br />Date: 12/01/2014 <br />Permit: M2004009 <br />$216.00 <br />Receipt Total: $216.00 <br />Page 1 of 1 <br />