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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977347 <br />Hoicim (Us) Inc. Receipt #: 27185 <br />Derrick Dease Date: 08/03/2018 <br />3500 Highway 120 <br />Permit: M1977347 <br />Florence CO 812260000 <br />Check #32010 4300-MTRO Minerals Technical Revision $216.00 <br />User: sdt <br />Payer: Western States Reclamation Inc <br />TR02 <br />Receipt Total: $216.00 <br />Page 1 of 1 <br />