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III IIIIIIIIIIIIIIII <br />999 <br /> <br />- MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Limited Impact (110) Operator eG ,~~ ~ <br />Special 10-D~y (111) Mine Name ~ r e Nom - ~i_ fo7 <br />Complete (r a ate 9- io• 8 ~ ~"~'~ <br />~_ <br />~~ <br />Appl ication Form: S~^" <br />I TEMs 1 2 3 ~~ 5 6 7 <br />Complete: ~ ~ ci ~'`;' sf,, ~ v v ~ <br />D. t/, n r ~ ~~7 <br />f.~ ~~ <br />ITEMS - - <br />Complete: - 8 <br />cr 9 <br /> <br />~- 10 _ <br /> <br />v 11 <br /> <br />~ 12 <br /> <br />~ 13 <br /> <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and Exhibits: <br />EXHIBIT A -Legal Description i,- / <br />EXHIBIT B -Site Description <br />a. Vegetation & Soils }/ <br />A ~.Y1.. 1 /IR l <br />b. Wildlife <br />c. Critical Structures <br />within 200 feet i/ <br />off-site damage G / _ / <br />EXHIBIT C -Mining Plan ~( <br />- ~_ ---- ~ ~/ I - <br />/~ <br />EXHIBIT D -Reclamation Plan <br />a. P1 an <br />f'~ O~~ f'Y` K <br />_ 1~~. ~ f; <br />'^- l O/ <br />r-w~'l/ , <br />