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AVS Annual Review <br />Inspection Worksheet <br />Date 06k"v_l- <br />Mine Name/Permit Number ��✓���� /^C� ����d ��� <br />Inspector Signature <br />Based on your ON -SITE Observation, please answer the following: <br />1) Mine ID sign <br />a) Permittee <br />b) Operator <br />��►�,7- <br />"013 <br />DMSIC <br />MIN,. ATION <br />`y <br />C) MSHA (not required to be on sign) <br />2) Direct inquiry (of persons on the site) JJ <br />a) Permittee L�► C-0 1i 44 <br />b) Operator ��'1r�' n )^') C &f C', 6e::� <br />C) MSHA <br />3) Is ownership /control information for permittee and operator noted in field consistent with <br />what is listed in the permit application? Yes No <br />If No, what is in conflict? <br />a <br />DRMS is required to verify this information as specified in the AVS MOU if the permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions). Annually as long as coal <br />extraction from the site has not been completed, DRMS must determine whether officer /controller <br />information is complete and accurate in AVS. In making the determination of complete and accurate <br />information, on -site observations and direct inquiry of persons on the site is necessary. The information <br />on this form will be verified with AML, MSHA, and EIA information in AVS. Please return the form to <br />Mary Rodriguez to be verified in the AVS. <br />