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09/23/2011 <br />P 5 7 <br />09:37 <br />Received: <br />M I is,INESOTA • R EVEN l) <br />Contractor's Withho ding:Affidavit <br />Confirmation <br />MID STATE RECLAMATION INC <br />Please keep this information fur your;records. <br />Submit a copy of this page to he business that hired you to receive you tine payment, <br />L I , <br />Confirmation number 405608 Fri Sep 23 09:21:19 CDT2011. <br />Project owner : CITY OF LINO LAKES <br />Project number 1-1132 <br />Project begin date May 2011 <br />Project end date : May 2011 <br />, t <br />Project location 1 2011 OVERLAY PROJECT, LINO LAKE,.MN <br />Subcontractors ; No Subcontractors listed, <br />ID 1719563 <br />Sep 23 2011 09:40am <br />(FAX) <br />https://wvvw,mndor.state.mnai /wc/action/confirrnationPrint <br />P.001/001 <br />Page 1 of 1 <br />9/23/2011 <br />