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1 <br />Assessment of Impact: <br />rrerarcd By: <br />Submitted Bv: <br />MINED LAND WILDLIFE STATEMENT /EVALUATIONN (Revised) <br />for limited impact and select regular sine applications <br />r ollowing information pertaining to wildlife is provided for use by Hined Land <br />mation Board in their consideration of • mining permit for: <br />Name /Type and Location of Hine (Legal) <br />wildlife Species list: Nongame birds, small mammals, waterfowl <br />Endangered. /critical speciesiimpacted: N/A <br />Critical habitats /vegetative communities impacted: <br />Minimal <br />.tine P.•cl.mition recommendations (include key species /habitats for which restoration <br />is designed). <br />Consult SCS for reclamation plan and follow their recommendations <br />N/A <br />T1iis statement is void if not processed within 1 year. <br />This analysis does not constitute approval or application. <br />Date: 8/"6 <br />Date: <br />