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• ~ III III'll llll'11111 <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />111 Special 6peration Operator -~~ ( "jf'7~iyl~ <br />Mine Name _ F~~r15 p; <br />File No. ~~~ Submittal Date 1p~o`1$~~4( <br />Application Form <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> <br />MAPS and EXHIBITS ...... ADEQUACY COMMENTS <br />EXHIBIT A - Legal Description 8 Location Mao <br />EXHIBIT B - Site Description / <br />a. Yegetation 8 Soils / <br />b. Critical Structures within 200 feet and offsite damage <br />c. Wildlife and Water Resources <br />EXHIBIT C - Mining Plan <br />EXHIBIT_D - Reclamation Plan <br />---a. Plan--- <br />