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4/77 <br /> MINED LAM RECLAMATION <br /> LIMITED TXPACT AM SPECIAL 10-DAY PERf$IT APPLICATION CHECKLIST <br /> File No.773 Name PWS�6 �wo0� Date of Filing (Completeness) : <br /> ITEM COMPLETE ADEQUATE COMMENTS <br /> Application Form <br /> 1. Name of operation <br /> 2. Name of applicant/operator <br /> 3. Address & phone (local offices) <br /> 4. Address & phone (general offices) <br /> 5. Person to contact <br /> 6. Surface owners ✓ <br /> 7. Mineral owners <br /> B. Type of mine/substance ✓ <br /> 9. General location & elevation / <br /> 10. County <br /> 11. Acreage <br /> 12. Fee V71 / <br /> 13. Present land use <br /> 14. Proposed future use <br /> 15. Signature V <br /> Maps and Exhibits / <br /> 1. Exhibit A - Legal description <br /> 2. Exhibit 3 - Mining plan <br /> 3. Exhibit C - Map ✓ ;a <br /> 4. Exhibit D - 'dildlife, Water Resource <br /> Vegetatiolfand Soils✓i for- <br /> mation <br /> 5. Exhibit E - Reclamation plan ✓ J <br />