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-' • III IIIIIIIIIIIII III • <br />999 <br />MINED LAND RECLAMATION <br />Application Norksheet/Checklist <br />Regular 112 Appl ication Operator n rF 5 ~~C.-• <br />Mine Name ~ ~ i ie No. -~{/ -~ <br />( i e Date 327/9/ <br />Application Form: <br />ITEMS <br />Complete: 1 2 3 4 I 5 ~ <br />I ~ 6 7 <br /> / / <br />ITEMS <br />Complete: 8 9 <br />I I 10 <br />` 11 I 12 I <br />I` 13 <br /> ' / <br />v / <br />/ ~ / <br />/ <br />COMPLETENESS/ADEQUACY COriMENTS <br />Maps and E:thibits: / <br />EXHIBIT A •- Legal Description/ <br />EXHIBIT B •• Index 1•tap <br />EXHIBIT C -• Pre-(dining & Mining Plan Maps <br />of Affected Lands <br />EXHIBIT D - Mining P1 an <br />EXHIBIT E - Reclamation Plan <br />