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Asphalt Specialties Co., Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004009 <br />Receipt #: 13357 <br />Date: 07/20/2012 <br />Permit: M2004009 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />22552 jwd <br />4300 -03 <br />Minerals Amendment Fees <br />M- 2004 -009 <br />$2,229.00 <br />Receipt Total: I $2,229.00 <br />Page 1 of 1 <br />