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It% <br /> Page: 1 of 1 <br /> Holcim <br /> Vendor No.: 2000311 Payment No.: 2000600260 Payment Date 10-09-2014 Check No. <br /> ' Invoice Number Invoice Date P© Number Invoice Amount [discount Net Amount <br /> 10082014DIV 10/08/2014 216.00 0.00 216.00 <br /> 1 ------------------ <br /> Check Total............................. 5 216.00 <br /> Send All Inquiries to Attention:Accounts Payable Holcim (USI Inc., 24 CROSBY DRIVE, BEDFORD,MA,01730, USA Telephone: 1-800-854-4656 <br /> DETACH FROM CHECK AND KEEP FOR YOUR RECORDS <br /> Holcim AM RIVE Inc. JPMorgan Chase Bank, N.A. <br /> 24 CRO V CHECK <br /> BEDFORD, MA, 01730 Syracuse, NY, NY,USA <br /> j Holcim DATE 10-09-2014 � <br /> MM OD YYYY <br /> <br /> TWO HUNDRED SIXTEEN DOLLARS AND ZERO CENTS $ **216.00 <br /> i <br /> PAY TO THE ORDER OF <br /> DIV OF RECLAMATION, MINING AND SAFE <br /> 1313 SHERMAN STREET ROOM 215 <br /> DENVER CO 80203 <br /> <br />