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Attachment A* <br />To be completed only if inventory sites are identified in I.D. <br />(attach additional sheets if necessary) <br />1.a. Impact on Resource from Proposed Development <br />1.b. Proposed Mitigation <br />2.a. Impact on Resource from Proposed Development <br />2.b. Proposed Mitigation <br />Certification and Signatures* <br />Statement by Applicant - I certify that the information presented by me in this application is accurate to <br />the best of my knowledge, information, and belief. <br />___________________________________________________ ___________________________________________________ <br />Applicant Date <br />85