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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2010043 <br /> Chamberlain Concrete Receipt#: 22210 <br /> Mason Chamberlain Date: 09/22/2016 <br /> 36415 U. S. Highway 385 <br /> P O Box 425 Permit: M2010043 <br /> Wray CO 807580000 <br /> MethodPayment Revenue CodeDescription/Notes <br /> Check#5951 4300-MAFO Minerals Annual Fees $323.00 <br /> Due 9/22/16 <br /> Receipt Total: $323,00 <br /> Page 1 of 1 <br />