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102 <br /> E E <br /> f <br /> `V?'e �i y"" -! y E `... 'i ,Atta�h1�� -'4- -t- E r `� F. .• <br /> Ta be complet ed only if inventory sites are ic entified in I.D. <br /> (attach additional sheets if necessary) <br /> J <br /> 'J a 'iMOIR on'Resource from Proposed De��lopmen't <br /> 1.b:Proposed Mitigation <br /> 2.a..Impact on.Resource from Proposed Develop rent <br /> I <br /> 2.b Proposed Mitigation <br /> FCertffrcation anti Signature$ <br /> Statement by A cant- certify that the"information presented`b, me in this ,.. � <br /> the best of my n e Y s application �s accurate to <br /> 'nformation, and belief. <br /> 2Y 2-3 <br /> Applicant Date <br /> Page 5 of 5 <br />