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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1975009 <br />The Lakewood Brick and Tile Company <br />�IIITII1 <br />Receipt #: 20303 <br />Date: 09/24/2015 <br />Permit: M1975009 <br />may nt Method 6 Code Fee De /Notes A rt` , <br />122353 SDT <br />4300-MAFO <br />Minerals Annual Fees $323.00 <br />M1975-009 <br />Receipt Total: $323.00 <br />Page 1 of 1 <br />