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P A Y E E: DGACH THIS STATEMENT BEFORE DEPOSITING <br />HARD ROCK PAVING & REDI MIX, INC. <br />--r <br /> <br />GATE <br />ACCOUNT OR <br />wvgCE ND <br /> <br />DESCRIPTION AMOUM <br />U$CDUNT OR <br />~~~ <br /> <br />NET AMOUNT <br /> <br /> PERMIT H M-77-i96 <br /> <br /> ~s~_~ <br />EMPLOYEE'S <br />NAME 1 <br />HARD ROCK PAVING 8 REDI MIX. INC. <br />' <br />~ <br />D 'I <br />HOURS <br />RATE <br />~ D D 0 M <br />~ ~ D ~ ~ a O W ~ HET <br />EAANIHGS <br />ENDING EAP <br />H GS FED. NTfH STATE H <br />" PAq <br /> F.ILA TAN . <br />TA% <br /> HEG T <br /> OT <br />VPR 6 EMPLOYEE THIS IS A STATEMENT OF YOUR EARNINGS AND DEDUCTIONS FOR PERIOD INDICATED KEEP THIS FOq YOUR PERMANENT RECORD <br /> <br /> MINED LAND RECLAMATION DIVIS, N~ 3535 <br /> 1313 Sherman Street Room 423 <br />Denver, CO, $0203 ' DATE <br />~s <br /> (303) 966-3567 <br />~ <br /> `/)y/~~ ~~ <br />RECEIVEG'rXiOM T • <br />" <br />~ <br />F <br />- <br /> / <br />~ <br />/ <br />~ <br />C~'~ ~ oLLAR$ $ 5O. ~/ <br />THE S <br />U <br />M <br />O <br />F <br />~/ <br /> ~ <br />``-7, <br />/ <br />~ <br />, <br />^ <br />FOR W^~/1~ Y~P_ ~ - 77 - l ~~i ~1~~0~ 0 yo cK <br /> AMOUNT OF ACCOUNT...... $ <br />tianl~ oul <br /> AMOUNT PAID ................ $ <br />' <br /> BALANCE DUE ............... $ BY . <br /> <br />