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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004020 <br />Receipt #: <br />Date: <br />4213 <br />M.A. Concrete Construction, Inc. <br />Permit: <br />000000000 <br />21638-mr1 14300-01 1 Minerals Annual Fees <br />M-2004-020 <br />10/16/2008 <br />M2004020 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1