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111111 ~ i <br />~ III1111111111 <br /> MINED LAND REC LAMATION <br /> l <br />Application Worksheet/Check <br />i <br />st <br /> ' <br />/ <br />_ <br />C +1 <br />J <br />0. <br />Limited Impact 110(2) Operator: i <br />-y1C l\ <br />lrn UC <br />_ <br /> Mine Name: r <br />2 <br />rOld I'1 bin <br /> Mine ID.: q a . °~ Submittal Date: <br />Application Form <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br /> / / <br />J / / <br />l <br />ITEMS 7 8 9 10 11 12 <br />• COMPLETED <br />-~,~ ~5 <br /> <br /> <br />MAPS and EXHIBI75 ADEQUACY COMMENTS <br /> / <br />EXHIBIT A - Legal Descrip tion & Location Map <br />EXHIBIT B - Site Description <br />a. Vegetation & Soils / <br />b. Wildlife <br />c. Critical structures within 200 feet and offsite damage <br />EXHIBIT C - Mining Plan <br />EXHIBIT D - Reclamation Plan <br />a. Plan <br /> <br />