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Page: 1 of 1 <br /> Holcim <br /> Vendor No.: 2000311 Payment No.: 2000600260 Payment Date 10-09-2014 Check No. 6000015622 <br /> Invoice Number Invoice Date PO Number invoice Amount Discount Net Amount <br /> 10082014DIV 10/08/2014 216.00 0.00 216.00 <br /> ------------------ <br /> Check Total............................. 8 216.00 <br /> Send All inquiries to Attention: Accounts Payable Holcim (US) Inc., 24 CROSBY DRIVE, BEDFORD, MA,01730, USA Telephone: 1-800-854-4656 <br /> DETACH FROM CHECK AND KEEP FOR YOUR RECORDS <br /> r• • • r• <br /> Holcim_LUS) Inc. JPMorgan Chase Bank, N.A. <br /> CRO CHECK J! 6 0 0 0 015 6 2 2 <br /> BED V RIVE <br /> DFORD, MA, 71730 Syracuse, NY, NY,USA <br /> DATE 10 09 2014 <br /> Holcim <br /> MM DD YYYY <br /> W937r213 <br /> TWO HUNDRED SIXTEEN DOLLARS AND ZERO CENTS <br /> $ 216.00 ' <br /> PAY TO THE ORDER OF: <br /> DIV OF RECLAMATION, MINING AND SAFE <br /> 1313 SHERMAN STREET ROOM 215 <br /> DENVER CO 80203 <br /> i <br /> un60000 L 56 2 20 1:0 2 L 309 3 79i: 500008 7 300 <br />