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<br />•\ • III III'111111111 III • <br />DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Limited Impact 110 Mining Operation <br />Application Worksheet/Checklist <br />New App: ~ Amendment App: Conversion App: <br />Operator: FiI~YI' r:llln~~) Mine ID: 1~7~01 p~J(f~ <br />Mine Name: f IL,~ ~~~Ll 1 ~Vlf.U2~ P,~. Submittal Date: ~~3i~0 ~ <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />ITEMS <br />COMPLETED 1 2 3 4 5 6 <br /> `~ ~ v <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> / ~/ / ~/ <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> 1~3~ 3~ <br /> ' 4~ 5,/6/ <br /> '1/ 8~ ~ <br />MAPS and EXHIBITS (Rule 6.2 & 6.3) <br />ADEQUACY COMMENTS <br />EXHIBIT A - 6.3.1 - LEGAL DESCRIPTION & LOCATION MAP,// <br />