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` III IIIIIIIIIIIIIIII ~ <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Limited Impact (110) Operator ~1 ~ ~. <br />Special 10-Day (111) Mine Name ~ i e o. - <br />Complete ( e ate <br />Application Form: <br />ITEMS 1 2 3 4 5 6 7 <br />Complete: <br />l~ w~cSS~~, Olt v y <br />ITEMS 8 9 10 11 12 13 <br />Complete: <br /> <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and Exhibits: <br />EXHIBIT A - Legal Description <br />EXHIBIT B - Site Description <br />a. Vegetation 8 Soils / p <br />{~ 'O l ~l <br />b. Wildlife <br />/ ~d ~ S l u.~-}cui~,~ <br />c. Critical Structures <br />within 200 feet ~~~~ <br />off-site damage <br />EXHIBIT C -Mining Plan ~~.~ 1 ~ ~,~~5 ` <br />EXHIBIT G - Reclamation Plan `/ <br />a. Plan <br />In,CLv~ SCS Iv~~~-v„~ <br />