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AVS Annual Review <br />Inspection Worksheet <br />Date -6? Pr,VL'a'' %,3 <br />Recely � <br />OCT 2 41013 <br />Mine Name /Permit Number I r r/'0 <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 />C) <br />MSHA ID <br /> <br /> required to be on sign) <br />2) Direct inquiry (of persons on the site) <br />a) Permittee �� �� �� L L <br />b) OperatorP �- <br />c) MSHA ID <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 />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 />