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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1983011 <br />Receipt #: <br />Date: <br />Permit: <br />7641 <br />03/01/2010 <br />M1983011 <br />Jelen & Son, Inc. <br />000000000 <br />12585 4300-01 Minerals Annual Fees <br />M-1983-011, Paid By Design West, LLC/Peak Repair, LLC <br />$259.00 <br />Receipt Total: $259.00 <br />Page 1 of 1