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• i III IIIIIIIIIIIII III <br />999 <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Limited Impact (1]0) Operator ~ T= C C.er s - <br />Special 10-D~y (111) Mine Name 1'Y1r a No, i- - <br />Complete (~ a ate <br />Application Form: <br />I TEMs <br />Complete: 1 2 3 4 5 6 7 <br /> <br />ITEMS <br />Complete: 8 9 1D 11 12 13 <br /> / ,/ / / <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and Exhibits: <br />EXHIBIT A -Legal Description / <br />EXHIBIT'S - Site Description <br />D a. Vegetation b Soils <br />b. Wildlife r' <br />c. Critical Structures <br />within 200 feet <br />off-site damage <br />EXHIBIT C -Mining Plan ~ <br />9 <br />EXHIBIT 9 - Reclamation Plan <br />~ a. Plan <br />t <br />