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.. ~' ~ '~` <br />MINED LAND WILDLIFE STATEMENT/EVALUATION (Revised) <br />for limited impact and select regular mine applications <br />The following information pertaining to wildlife is provided for use by Mined Land <br />Reclamation Board in their consideration of a mining permit for: <br />Name/Type and Location of Mine (Legal) <br />Wildlife Species list: <br />Endangered/critical species/impacted: <br />Critical habitats/vegetative communities impacted: <br />Assessment of impact: <br /> <br /> <br />Nine Reclamation recotmnendations (include key species/habitats for which restoration <br />1s designed). <br />Prepared By: Date: <br /> <br />Submitted By: Date; <br />This statement is void if not processed within 1 year. <br />This analysis does not constitute approval of application. <br />