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<br />DIVISION OF MINERALS AND GEOLOGY <br />Limited Impact 110 Construction Materials Operation <br />Application WorksheeUChecklist <br />New App: / Amendment App: Conversion App: <br />Operator: Park Countv Mine ID: M-97-035 <br />Mine Name: Chaparral #2 Submittal Date: 5130/97 <br />APPLICATION FORM (Rule 1.4~ <br />APPLICATION ITEMS COMPLETED <br />------ ~------- ------ ~ ------ ------ 3 ------ ------ 4 ------ ------ 5 ------ ------ 6 ------ ------~ ------ <br />/ / / / / OK OK <br />------ 8 ------ ------ 9 ------ ----- ~ ~ ----- ----- ~ ~------ ------~ ~ ----- ----- ~ 3 ----- ----- ~ 4------ <br /> <br />Initials Signature Notices COMMENTS: <br />/ / / <br />EXHIBITS <br />A <br />-------------- B <br />-------------- C <br />-------------- D <br />-------------- E <br />-------------- F <br />-------------- G <br />-------------- <br />/ / / / / / / <br />H I J L Geotech Sign Affid. <br />/ / / OK OK <br />COMPLETENESS COMMENTS: <br />Exhibit L -Permanent Man-Made Structures, may require additional documentation <br />This is a new site adjacent to an existing 110, M-95-021 <br /> <br />