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<br />r. ~•~ • II I III III I II IIII III <br />999 <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist // <br />Limited Impact (110) Operator 1F t ~./•~ Gy~L~~/2d~iv~P~o. <br />Special 10-Day (T11 ) Mine Name ~~L ; - ,,,,r~'YTe No. M-_ 7-ice <br />Complete ( i e ate <br />~~F <br />Application Form: <br />ITEMS <br />Complete: 1 <br />~ 2 <br />/ 3 <br />/ 4 <br />/ 5 <br />Y 6 <br />,~ 7 <br />~-- <br /> <br />ITEMS <br />Complete: 8 <br />/ 9 <br />/ 10 <br />/ 11 <br />ci 12 13 <br />`'~ <br /> <br />COMPLETENESS/ADEQUACY COMMENTS <br />Maps and Exhibits: <br />EXHIBIT A -Legal Description / <br />EXHIBIT B - Site Description ~ <br />a. Vegetation 8 Soils c/ <br />b. Wildlife / <br />c. Critical Structures <br />within 200 feet <br />off-site damage <br />EXHIBIT C - Mining Plan ~ <br />EXHIBIT D - Reclamation Plan / <br />a. Plan / <br />