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AVS Annual Review <br />Inspection Worksheet <br />Date / <br />Mine Name/Permit Number & Z00908 <br />Inspector SignaturJe <br />Based on your ON -SITE Observation, please answer the following: <br />1) Mine ID sign <br />a) Permittee r�.E�{• �1r�.,r,,v LG e. <br />b) Operator S ,rl Wj <br />c) MSHA ID Qf -0¢QSZ (not required to be on sign) <br />2) Direct inquiry (of persons on the site) <br />a) Permittee iZVdrePe, <br />b) Operator .s r <br />C) MSHA ID <br />0�_-6 4.9,SZ <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 />DBMS 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 officericontroller <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 />