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~/ :. <br />APPENDIX B. III IIIIIIIIIIIII III <br />MINED LAND WILDLIFE STATEMENT 99g <br />For Limited Impact Operations ~F <br />• (Permit 110-1 and 110-2 ) or <br />Regular Operations (Permit 112) [[~~.`,~~~~ tlU( ~~/~jP <br />Instructions to the Applicant: Submit this Wildlife Statemerv-S)~` MLR~a$~a~ of the <br />MLR- O p ication. ``~ <br />~~~~5 <br />Instructions to DOW District Wildlife Manager: Review the attacf~lpplicant's <br />Questlornaire, comp ete t 1s orm, an send of ack to the Regional Office. 9y <br />Instructions to DOW Re Tonal Staff: Send completed copies of both the Applicant's <br />Questiomaire and Wildlife Statement along with pertinent correspondence to the <br />applicant, MLAD, and DWM. <br />The following information pertaining to wildlife is provided for use by the Mined Land <br />Reclamation Board in its cro~nsideration of a mining permit for: ~ I F',ly ~~. <br />1. Name and type of mine: rC ~ o ~~ v--w C i .~~~...~.~ ~C ~ rs~ T` T' yYl - aOpD -0 7~ <br />2. Location of mine: Sec 3 I T ! N tZ ~i~W ~~ 1~h'l ~ ~ ~ I~ a-u <br />3. List threatened or endangered species (federal or state) and other species of <br />special concern present: <br />l `L O ESL. <br />• <br />4. Assess expected impactsl_to fish and(~wildlife populations and habitat frrom protelct: <br />/~a.~-2. ~ 0. ~ l ~ W i l~. +~ ~ 0..-.._ aY 2 1R-r 1 lh S ~ r i yam, ~.l S C J~ ~ Ci~d~'~'~ <br />~OSS' o-~' ~r0.e1~ }'~.rpv~Cil~. CSJint~~o.,~e I C~~S~r-~~.,v\C.C~, <br />(OVER) <br />-12- <br />• <br /> <br /> <br />