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~ ~ III IIIIIIIIIIIII III <br />DIVISION OF MINERALS AND GEOLOGY <br />Limited Impact 110 Mining Operation <br />Application Worksheet/Checklist <br />New App: _ <br />Operator: <br />Mine Name: <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />OFF GE <br />Conversion App: <br />Mine ID : - ~, <br />Submittal Date: ~ (p <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br /> ~L.h'1 <br /> <br />ITEMS 7 8 9 10 11 ~ 12 <br />COMPLETED <br /> L YY1 <br /> <br />ITEMS CONV PERMTEE SIG <br />COMPLETED DESCP RESP <br /> ~ <br /> / / <br />4 <br />~J6~ <br /> / <br />/ <br />~9 <br />MAPS and EXHIBITS (Rule 6.2) <br />ADEQUACY COMMENTS <br />EXHIBIT A - 6.3.1 - LEGAL DESCRIPTION & LOCATION MAP V <br />EXHIBIT B - 6.3.2 - SITE DESCRIPTION <br />a. Vegetation & Soils - 6.3.2 (a) ~~e~ ~ `1~e.~c~SO! ~.s <br />