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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1997015 <br />Washington County <br />Jason Lockard <br />150 Ash Avenue <br />Akron CO 807200000 <br />Receipt #: <br />Date: <br />Permit: <br />22272 <br />09/30/2016 <br />M1997015 <br />Pa ment Method: <br />w:R evnue ode <br />_�e.__�_ ..C_4.... ::. - L Fee:DescriptionlPaid B i Other_EntitylNote. <br />AmountCheck <br />#83079 <br />;Minerals Civil PenaltyNiolation Fines <br />of If <br />Receipt Total: $500.00 <br />Page 1 of 1 <br />