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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1981004 <br />807230000COBrush <br />P O Box 125 <br />1941 Edmunds St <br />Gwen Dilley <br />Receipt #: <br />12/15/2016 <br /> 22671 <br />Date: <br />M1981004Permit: <br />Dilleys Sand & Gravel <br />Fee Description/Paid By Other Entity/NotesRevenue CodePayment Method Amount <br />Check #1152 $2,696.00 4300-MCNV Minerals Conversions <br />CN01 <br />Bengineers LLC <br />$2,696.00 Receipt Total: <br />Page 1 of 1