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<br /> <br />MINED LAND RECLAMATION <br />Application Worksheet(Checklist <br />Limited Impact (110) Operator ~ ~, Cq n~LL ~~/ <br />Special 10-D~y (111 ) Mine Name c.rr, ~ c e r-r , , i e o. - ~~-isv <br />Complete ( e ate <br />Application Form: <br />ITEMS <br />Complete: 1 2 3 4 5 6 7 <br /> t/ t/ r/ r/ t/ l/ <br />ITEMS <br />Comp1 ete: 8 9 10 11 <br />~ n.Pi9~o 12 13 <br /> ~/ d ~/ ~/ <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and Exhibits: <br />EXHIBIT A - Legal Description <br />EXHIBIT B - Site Description <br />a. Vegetation 8 Soils <br />~Gr <br />b. Wildlife / <br />c. Critical Structures <br />within 200 feet <br />off-site damage <br />EXHIBIT C -Mining Plan <br /> <br />.,~~ In ~o, ti~ ~ r,.rios,~~s <br />EXHIBIT D - Reclamation Plan <br />a. Plan <br />