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RECE — o °—) <br />OCT 2 4 <br />01 jgloNOF <br />MIIyjNO RE ...,, <br />AVS Annual Review ANA r <br />Inspection Worksheet <br />Date 2i l ) <br />Mine Name/Permit Number (� b l o w o M j t4 'P C_ J g ed r— o( r <br />Inspector Signature <br />Based on your ON -SITE Observation, please answer the following: <br />1) Mine ID sign <br />a) <br />b) <br />C) <br />Permittee Colo w e i7 CC7p rc"W r ot il y J <br />Operator C G f ° w y0 Co;d CG` M rOL,W � <br />MSHA ID © <br />L . I�q. <br />L' tp <br />(not required to be on sign) <br />2) Direct inquiry (of persons on the site) //±±��� <br />a) Permittee ( O 1� w � O C od & m fa i% j L' <br />b) Operator C v / n V'11'0 COCI C,'W JA K�j �. <br />C) MSHA ID ©� <br />3) Is ownership /control information for permittee a 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 AVS. <br />