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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1996064 <br /> The Denver Brick Company Receipt#: 28135 <br /> Robert Tibbetts Date: 02/11/2019 <br /> 401 Prairie Hawk Dr. <br /> Permit: M1996064 <br /> Castle Rock CO 801090000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> Check# 4300-MTRO Minerals Technical Revision $216.00 <br /> User: bjc <br /> Payer: Acme Brick Company <br /> Receipt Total: $216.00 <br /> • - <br /> „1.111111111111.1111011$11111146116tWalaleAr • , 4 .. <br /> ACME BRICK COMPANY CHECK NO. <br /> 4is Asmit-73 FEIBP Eattaq. DATE 1/24/2019 <br /> P.O.Box 426 • Fort Worth,TX 76101-0425 <br /> (817)332-4101 • brick.com PAYEE# <br /> PAY EXACTLY <br /> PAY TWO HUNDRED SIXTEEN AND 00/100*******"***************"* $*******216.00 <br /> EXACTLY <br /> pke444; <br /> PAY TO THE Division of Reclamation Mining & Safety (Authorized Signature) <br /> ORDER OF 1313 Sherman St Rm 215 <br /> Denver CO 80203 <br /> VOID AMER 120 DAYS <br /> litz 5- yr1 ienti (044,4 rorm3Chase Bank,NA,Dallas,TX <br /> : ''?`?:141i'411004.390PIVArtttler <br /> Page 1 of 1 <br />