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Asphalt Specialties Co., Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1983176 <br />Receipt #: 14215 <br />Date: 12/05/2012 <br />Permit: M1983176 <br />Payment Method t Revenue Code Fee Description /Notes <br />A i <br />ount <br />24698 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1983 -176 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />