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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004009 <br />11 ---------- " <br />Asphalt Specialties Co., Inc. <br />Rob Laird <br />10100 Dallas St. <br />Henderson CO 806400000 <br />Receipt #: <br />Date: <br />Permit: <br />23938 <br />08/01/2017 <br />M2004009 <br />JI�V <br />'Iii IT, AINY <br />Check #042145 <br />4300-MAFO <br />Minerals Annual Fees <br />$791.00 <br />User: sdt <br />Payer: Asphalt Specialties Co. <br />Due 8/4/17 <br />Receipt Total: <br />$791.001 <br />Page 1 of 1 <br />