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<br />~ III IIIIIIIIIIIII III ~ <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />~` L i re ~-C S~J~ ~c~ '~- <br />Limited Impact (110)' Operator ~ ~~vt <br />Special 10-Day (111) Mine Name ~~ i e o. - / -p <br />Complete (i a Date 3/Z (4( <br />Application Form: <br />I TEMs <br />Complete: 1 2 3 4 5 6 7 <br /> ~/ ~/ <br />ITEMS <br />Complete: 8 9 10 11 12 13 <br /> <br />>~ / <br />/ / <br />/ <br />~ <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and Exhibits: <br />EXHIBIT A - Legal Description <br />EXHIBIT B - Site Description <br />a. Vegetation & Soils <br />b. Wildlife <br />c. Critical Structures <br />within 200 feet <br />off-site damage <br />EXHIBIT C -Mining Plan <br />EXHIBIT D - Reclamation Plan <br />a. Plan <br />