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Asphalt Constructors, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001069 <br />Receipt #: 13977 <br />Date: 10/23/2012 <br />Permit: M2001069 <br />Payment Method <br />Revenue Code <br />Fee Descrptio!Notes Amount m <br />032179 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2001 -069 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />