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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977262 <br />General Shale Brick, Inc. <br />Tony Fabrizio <br />1845 W. Dartmouth Ave. <br />Denver CO 801101308 <br />Receipt #: <br />Date: <br />Permit: <br />22772 <br />01/13/2017 <br />M1977252 <br />TPayment Method <br />Reven`� a Cod <br />eerDescripti nlPaid By Oth--- Eh it' tes�Check <br />#0093235' <br />Minerals Annual FeesGeneral <br />Shale2017 <br />Receipt Total: $791.00 <br />Page 1 of 1 <br />