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GSLIBrush LLC <br />000000000 <br />(30\ <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001085 <br />Receipt #: 14536 <br />Date: 01/29/2013 <br />Permit: M2001085 <br />Payment Method Revenue Code <br />Fee Description /Notes ` " Amount <br />2110 <br />5700 <br />Minerals Civil Penalty/Violation Fines <br />M- 2001 -085, MV- 2012 -031, CMB <br />$500.00 <br />Receipt Total: I $500.00 I <br />Page 1 of 1 <br />