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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1994053 <br /> Base Products Receipt#: 22017 <br /> Tony Appelhanz Date: 08/16/2016 <br /> 62339 W LaSalle Rd <br /> Permit: M1994053 <br /> Montrose CO 814030000 <br /> MethodPayment Revenue Code • . <br /> Check#4393 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />