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<br />DIVISIOiV OF MINERALS AND GEOLOGY <br />CONSTRVCTION MATERIALS <br />Regular (112). Mining Operation <br />Application Worksheet/Checklist <br />Operator: <br />Mine Name: <br />APPLICATION FORM (Rule 1.6..2 and 1.6.3): <br /> <br />Mine ID: /~/-`~7~"~ ~~/ <br />Submittal Date : ~-3 -ba <br />ITEMS <br />COMPLETED 1 2 3 4 5 6' <br /> I/ / '~ / ~ ~ <br />ITEMS- 7 8 9 10 11 12 <br />COMPLETED <br /> <br /> <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> 3/ L~ ?~ <br /> ~ `/e~ J <br /> •.~si ~ <br />MAPS and EXHIBITS (Rule 6.2) <br />netc~ Car~aia.fe sc~ <br />~o~~ <br />ADEQUACY COMMENTS <br />EXHIBIT A -,~ a.l - LEGAL DESCRIPTION:/ <br />New App: Amendment App: ~_ Conversion App: <br />