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Monument Dam <br />Inspection Form <br />Date: ' -21-2011,3 <br />Time: i 'oo <br />Name of Inspector: 1—o %e /a /16 <br />Current Panel Being Mined: Z -V KC /7 <br />❑ Weekly Inspection [,Monthly Inspection <br />Yes No <br />❑ )Z( Is mining within 1 mile of Monument Dam? <br />❑ o� Are there visible surface cracks on the dam? <br />If yes, indicate length and size of crack. <br />n <br />Is there evidence of subsided areas on or around dam? <br />If yes, indicate where and degree. <br />❑ ❑ \ Are there bulges on the dam? <br />If yes, indicate where and degree. <br />❑ K Are there signs of seeps on the dam? <br />If yes, indicate where and estimated flow. <br />❑ ❑ <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 />A)1f �t(VI.4 fib /.e 61U_1 /_6 Jl-)owy r�ooCi <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 <br />immediately. <br />