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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2OO21O9 <br />A. Blasi &Son Trucking & Earthmoving, LLC <br />Receipt#: 21544 <br />Anthony Blasi Date: 05/27/2016 <br />38043 CR 32.4 <br />Permit: M2002109 <br />Trinidad CO 810820000 <br />Payment Method Revenue Code Fee Description/Notes Amount <br />Check#53296 4300-MAFO Minerals Annual Fees 323.00 <br />2016 <br />Receipt Total: 323.00 <br />Page 1 of 1