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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2O18O15 <br /> Fremont Paving & Redi-Mix, Inc. Receipt#: 28763 <br /> Jodi Schreiber Date: 05/31/2019 <br /> 839 Mackenzie Ave <br /> PO Box 841 Permit: M2018015 <br /> Canon City CO 812120000 <br /> Method Revenue Code Fee Description/Notes Amount — <br /> Check#100628 4300-MTRO Minerals Technical Revision $216.00 <br /> User: sdt <br /> TR01 <br /> Receipt Total: $216.00 <br /> Page 1 of 1 <br />