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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1983176 <br />Asphalt Specialties Co. <br />10100 Dallas St. <br />Henderson CO 806400000 <br />11521 I 4300-03 I Minerals Amendment Fees <br />M-1983-176 <br />Receipt #: <br />Date: <br />Permit: <br />6411 <br />08/21/2009 <br />M1983176 <br />$2,229.00 <br />Receipt Total: $2,229.00 <br />Page 1 of 1