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4/77 <br />• . III 1111111911111111 <br />MIi7ED LA.~ID RECLA2IATIOiI <br />LIMITED Ir[PACT AND SPEC 10-DAY PERiiI ICATION CF.ECKLIST <br />File No.7~NameC.Z2 N. - M ~V& ~"f- Date of Filing (Completeness) <br />ITEM CO`c7PLETE ADEQIIATE CO~ASEiTTS <br />application Fora <br />I. Name of operation <br />7 <br />2. name of apnlicaat/operator ~ ~ <br />3. address & phone (local offices) ~ / <br />4, address & phone (oeaeral offices) ,7 ~-~ <br />5. Person to contact <br /> <br />5. Surface o~mers <br />~ I I <br />7. :fineral owners <br />8. Type of mine/substance <br />9. General location 5 elevation i <br />I0. County ', <br />/ <br />11. acreage ~ j~3 <br /> <br />12. c'ee r <br />7 ~ <br />~ <br />I3. Present land use ~' ~ <br />l <br />14. Proposed future use ~~~~ ~ <br />i <br />15. Signature 7 ~ <br />Maps and Exhibits <br />1. E.ihibit a - Legal description <br />~ <br />Z. Exhibit B - .aping plan ~ ~ f <br />3. Exhibit C - ?1aa <br />,• . E:chibit D - 'dildlife, tdater Resources, <br />7egetatioa and Soils iaror- <br />mati.nn <br />5. Exhibit E - Reclamation plan ~~3 <br />