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<br />.~ <br /> <br />111 Special Operation <br />Application Form <br />ITEMS <br />COMPLETED <br />r <br />1 2 3 4 5 6 <br />1/ 1/ ~/ / ~/ ~/ <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Operator: ~_5 <br />Mine Name: <br />Mine ID.: rn_9y°7y Submittal Date: <br />ITEMS 7 8 9 10 11 12 <br />COMPLETED <br />~/ / / ~ / ~ <br />MAPS and EXHIBITS ADEQUACY COMMENTS <br />EXHIBIT A - Legal Description & Location Map <br />o ,ic o K <br />EXHIBIT B - Site Description <br />a. Vegetation & Soils <br />oK <br />b. Critical structures within 200 feet and offsite damage <br />oK <br />c. Water Resources and Wildlife Statement (if provided) <br />oK <br />EXHIBIT C - Mining Plan <br />~~ <br />EXHIBIT D - Reclamation Plan <br />a. Plan <br />~~ <br />