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General Shale Brick, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977252 <br />Receipt #: 13835 <br />Date: 10/03/2012 <br />Permit: M1977252 <br />Payment Method Revenue Code Fee Description /Notes <br />Amount <br />795993 jwd <br />4300 -11 <br />Minerals Technical Revision <br />M- 1977 -252 <br />$216.00 <br />Receipt Total: I $216.00 <br />Page 1 of 1 <br />