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~ iiiiiiiii ~ <br />MINED LAND RECLANWTION <br />Application Worksheet/Checklist <br />Regular 112 Application Name R C M„~k G,,.rtr,.~f;,,,, co, file iVo. ~3-143 <br />Complete (Filed Date o~;r. !`~,~s~3 <br />~~R.c ~towl~r P/..,~~r" <br />ITEM COMPLETE ADEQUATE COMMENTS <br />Application form: <br />1. Name of Operation <br /> x x <br />2. Name of Applicant/Operator <br /> X X <br />3. Address ffi Phone (Local) <br /> ~ ~ <br />4. Address & Phone (General) <br /> ~ <br />5. Person to Contact <br /> x x <br />6. Parent Corporation, if any <br />7. Surface Owners <br />d. Mineral Owners <br /> X X <br />y. Source of Legal Right-To-Enter x <br /> ~ <br />10. Type of Mine/Suostance <br />11. General Location & Elevation <br /> <br />12. County <br /> X <br />13. Acreage <br /> <br />14, fee <br /> X <br />15. Present Land Use <br /> K <br />10. Jurrounding Land Uses <br /> ~ ~ <br />17. Proposed Future Use <br /> <br />