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Monument Dam <br />Inspection Form <br />Date: 7- / 7 - 3 <br />Time: l.'4(3 <br />�'/►� <br />Name of Inspector: ­.% h-'V O I14 o� <br />Current Panel Being Mined: �Fj( <br />❑ Weekly Inspection V Monthly Inspection <br />Yes No <br />❑ V Is mining within 1 mile of Monument Dam? <br />❑ Are there visible surface cracks on the dam? <br />If yes, indicate length and size of crack. <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 />❑ Are there signs of seeps on the dam? <br />If yes, indicate where and estimated flow. <br />r� Are there any other potentially damaging features on the dam? <br />If yes, describe. _ <br />C] Are there any recent evidences of slope failure on the landside south of the <br />dam (perform visual inspection mad d <br />If yes, describe. 9 <br />Notes: 1)),f;V)2 l- t LIrL_ ,f /?d k 2 0 -CT R Cl-dui S p,,j_W'tV <br />Signature of Inspector: Lj / <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 />Wendell Koontz immediately. <br />