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~, ~ III IIIIIIIIIIIIIIII i <br />' MINED LANG RECLAMATION <br />Application Worksheet/Checklist <br />Limi ted Impact 110(2) Operator: ~~ , ~,+nc~ <br />Mine Name : ~e~ 'P i+ <br />Mine IO.: Qa-O'-t Submittal Date: ~ a0 a <br />Application Form <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br />ITEMS 7 8 9 10 11 12 <br />COMPLETED <br />i / i i .~ <br />MAPS and EXHIBITS ADEQUACY COMMENTS <br />EXHIBIT A - Legal Description & Location Map <br />EXHIBIT 8 - Site Description <br />a. Vegetation & Soils <br />b. Wildlife <br />c. Critical structures within 200 feet and offsite damage ~ <br />EXHIBIT C - Mining Plzn <br />EXHIBIT 0 - Reclamation Plan <br />a. Plan ,~ <br />