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<br />• ~ III IIIIIIIIIIIIIIII <br />MINED LAND RECLAMATION <br />implication Worksheet/Checklist <br />Limited Impact (110) Operator Y~ip~~ l-nu~,~.~y <br />Special 10-Day (111) Mine Name Gr '~ F~ a No. - O-t g <br />Complete (i a Date <br />Application Fonn: <br />ITEMS 1 2 3 4 5 6 7 <br />Complete: <br />ITEMS <br />Complete: B 9 10 11 12 13 <br /> / / / / / -/ <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and E:Khibits: <br />EXHIBIT A - Legal Description <br />EXHIBIT B •- Site Description <br />a, vegetation 8 Soils / <br />b. Wildl ife <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 />