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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2004009 <br /> Asphalt Specialties Co., Inc. Receipt#: 21931 <br /> Rob Laird Date: 08/02/2016 <br /> 10100 Dallas St. <br /> Permit: M2004009 <br /> Henderson CO 806400000 <br /> MethodPayment Revenue Code <br /> Check#037316 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />