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<br />• MINED LAND RECLAMATI~ III III III IIIIIIIIII <br />Application Worksheet/Checklist <br />Limited Impact 110(2) Operator: ~I~~~ l (~uv~.~ <br />il( -~~> (bo(a) Mine Name: FC'.v~~'is ~~~' <br />M ne ID.: 1~ c z3 Submittal Date: ~ ~/C" <br />Application Form <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br />MAPS and EXHIBITS ADEQUACY COMMENTS <br />EXHIBIT A - Legal Description & Location Map. <br />EXHIBIT 8 - Site Description <br />a. Vegetation & Soils ~~ <br />b. Critical structures within 200 feet and offsite damage <br />c. Water Resources and Wildlife Statement (if provided) <br />EXHIBIT C - Mining Plan <br />EXHIBIT D - Recla ation Plan <br />a. Plan <br />