2011-07-07_PERMIT FILE - M2011036 ‎(2)‎

• Permit No: M2011036
• IBM Index Class Name: PERMIT FILE
• Doc Date: 7/7/2011
• Doc Name: New 112c permit application
• From: Moffat County
• To: DRMS
• Email Name: DMC
• Media Type: D
• Archive: No

APPENDIX B.
MINED LAND WILDLIFE STATEMENT
For Limited Impact Operations
(Permit 110 -1 and 110 -2 ) or
Regular Operations (Permit 112)
Instructions to the Applicant: Submit this Wildlife Statement to MLRD as part of the
MLRD application.
Instructions to DOW District Wildlife Manager: Review the attached Applicant's
Questionnaire, complete this form, and send both back to the Regional Office.
Instructions to DOW Regional Staff: Send completed copies of both the Applicant's
Questionnaire and Wildlife Statement along with pertinent correspondence to the
applicant, MLRD, and DWM.
The following information pertaining to wildlife is provided for use by the Mined Land
Reclamation Board in its consideration of a mining permit for:
1. Name and type of mine:
2. Location of mine:
3. List threatened or endangered species (federal or state) and other species of
special concern present:
4. Assess expected impacts to fish and wildlife populations and habitat from project:
(OVER)
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