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• III IIIIIIIIIIIII III • <br />MINES ~nnu I~CI.L/v'~~. ~vr~ <br />Application Worksheet/Checklist <br />Limited Impact 110(2) Operator _~i-~- CLU`SOVI ~~~~,,,-~.~ <br />Mine Name ~ - '( <br />File No. a~ Submittal Date c c <br />Application Form <br />ITEMS <br />COMPLETED 1 2 3 4 5 6 <br /> <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> / <br />MAPS .and.EXHIBITS.___.._..__._..__...._...___.....__....ADEOUACY_COMMENTS. _._ _ <br />EXHIBIT A - Legal Description-b-Cocation Map <br />EXHIBIT B - Site Description / <br />a. Vegetation 8 Soils / <br />b. Wildlife <br />S <br />c. Critical Structures within 200 feet and offsite damage <br /> <br />EXHIBIT C - Mining Plan <br /> <br />EXHIBIT D - Reclamation Plan <br />a. Plan <br />