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Monument Dam <br />Inspection Form <br />Date: /0 <br />Time: <br />Name of Insp tor: <br />Current Panel Being Mined: <br />❑ Weekly Inspection 21<onthly Inspection <br />Yes No <br />❑ 0"" Is mining within 1 mile of Monument Dam? <br />❑ —O`� Are there visible surface cracks on the dam? <br />1 If yes, indicate length and size of crack. <br />❑ q/ Is there evidence of subsided areas on or around dam? <br />( If yes, indicate where and degree. <br />❑ ❑ 1 Are there bulges on the dam? <br />lIf yes, indicate where and degree. <br />❑ Are there signs of seeps on the dam? <br />If yes, indicate where and estimated flow. <br />❑ ❑ Are there any other potentially damaging features on the dam? <br />If yes, describe. <br />❑ Are there any recent evidences of slope failure on the landside south of the <br />dam (perform visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Notes: <br />Signature of Inspector: ? <br />Inspections are performed under the direction of Jessica Loveland, P. E, <br />-If cracks or other potentially damaging features occur, notify Jessica Loveland or <br />�di °Ie�LJi� immediately. <br />