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_ III IIIIIIIIIIIIIIII ~ <br />• <br />- - MINED LAND RECLAMATION <br />Application Worksheet/Chec(k/l~isrt- <br />Limited Impact (110) Operator iNl Uf~"~ ~'~'~ <br />Special 10-Ddy (T 11 } Mine Name ,f~~i.od,c n,~- n~~. i ~ e No. - ~ti - rr z <br />Complete (~ a a6 to <br />Application Form: <br />ITEMS <br />Complete: 1 2 3 4 5 6 7 <br /> I/ <br />ITEMS <br />Complete: 8 9 10 _ 11 12 I 13 <br /> <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and Exhibits: <br />EXHIBIT A - Legal Description / <br />EXHIBIT B - Site Description <br />a. Vegetation & Soils <br />b. Wildlife ~/ <br />c. Critical Structures <br />within 200 feet i/ <br />off-site damage <br />EXHIBIT C -Mining Plan <br />EXHIBIT 0 - Reclamation Plan ~ <br />a. Plan <br />