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~ ~~ ~ ' • <br />APPENDix e. RECEIVED <br />MINED LAND WILDLIFE STA~TETIENT <br />For Limited Impact Operations C.~ ~(~// ~, NOV 0 7 ~gg4 <br />(Permit 110-1 and 110-2 ) or L//_ <br />Regular Operations (Permit 112) ((( <br />Division of Minerals s ueoiogy <br />Instructions to the Applicant: Submit this Wildlife Statement to MLRD as part of the <br />MLRD app ica ion. <br />Instructions to DOW District Wildlife Manager: Review the attached Applicant's <br />Questiornaire, comp ete t is form, an sen bot ack to the Regional Office. <br />Instructions to DOW Re Tonal Staff: Send completed copies of both the Applicant's <br />puestiomaire and Wild ife Statement along with pertinent correspondence to the <br />applicant, MLRD, and DWM. <br />The following information pertaining to wildlife is provided for use by the Mined Land <br />Reclamation Board in its consideration of a mining permit for: <br />1 <br />2 <br />3 <br />Name and type of mine: ,^1 ~„ n a ~c~ ~- <br />Location of mine • i~ ~ /l-V,1O5 A C4 <br />List threatened or endangered species <br />special concern present: N ~ ~ E <br />(federal or state) and other species of <br />4. Assess expected impac/ts to fish and wildlife populations and habitat from project: <br />N O S r u n~ -Yi cd~~ ~^^~ rJ a c"t S mo w. ~.O c. A F C O Q- h z 6 ~'~ <br />~ru-v~-~ -}~~S ~~o~..t /~r~Posc~ <br />(OVER) <br />g4~f,c~ <br />-~ Mr~E <br />No M-`1Y-~81 <br />-12- <br />