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~t ~ • III IIIIIIIIIIIIIIII • <br />999 <br />D]:VISION OF' nilLVnxEV~~ ruvu GEOLOGY <br />CONSTRUCTION MATERIALS <br />Limited Impact 110 Mining Operation <br />Application Worksheet/Checklist <br />New App: .Amendment App: ~ Conversion App: <br />Operator: ~1i~ ~,flX~~'' C()I,u~~ Mine ID: (~~d(P~ <br />Mine Name: Val I f.(~~fa~. PI -~' Submittal Date: ~ ~' ~~ ~/ <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br /> <br /> <br />ITEMS 7 8 9 10 11 12 <br />COMPLETED <br /> ~ / / c/ <br /> <br />ITEMS CONV/AtQEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> Y 2' 3' <br /> <br /> 7 ~B/9'~ <br />MAPS and EXHIBITS (Rule 6.2 & 6.3) <br />ADEQUACY COMMENTS <br />EXHIBIT A - 6.3.1 - ~'~AL DESCRIPTION & LOCATION MAP / <br />