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APPQ~IX B. • <br />• MINED LAND WILDLIFE STATE?1ENT <br />For Limited Lnpact Operations <br />(Permit 110-1 and 110-2 ) or <br />Regular Operations (Permit 112) <br />Instructions to the Applicant: Submit this Wildlife Statement to MLRD as part of the <br />MLRD app icafion. <br />Instructions to DOW District Wildlife Manager: Review the attached Applicant's <br />Questiomaire, comp ete t is orm, an sen of ack to the Regional Office. <br />Instructions to DOW Re Tonal Staff: Send completed copies of both the Applicant's <br />Questiomaire and Wi d ife Statement along with pertinent correspondence to the <br />applicant, MLRD, and DWM. <br />The following information pertaining to wildlife is provided for use by the Mined Land <br />Reclamation ooard in its consideration of a mining permit for: <br />1. Name and type of mine: 1~/.~~/.ar»~' r~~~e.f ~n~~r /'~~7~ ~~rn~r~~-f <br />2. Location of mine: fCi ~5~-„ /Z , 'Te~y ~ ~~ ~'1! r~ ~c~ 1~,.. 5~, ~, l~~ <br />3. List threatened or endangered species (federal or state) and other species of <br />special concernl.p/resen~tc: ~ c~i~f <br />~~~ 7 /I Mss/dnr~Br ~n C"o~dr~~..7~ <br />4. Assess expected impacts to fish and wildlife populations and habitat from project: <br />^,7 <br />///~nimn / ~~or J. <br />(OVER) <br />-12- <br />