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Monument Dam <br />Inspection Form <br />Date: /tea /i3 <br />Time: 1. '00e*t - / <br />Name of Inspector: /Ol./d. la4cl <br />Current Panel Being Mined: EY X 4 ,3' <br />❑ Weekly Inspection I CMonthly Inspection <br />Yes No <br />❑ fl-\ Is mining within I 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 />❑ d� Are there bulges on the dam? <br />JIf 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 darn? <br />If yes, describe. <br />❑ Are there any recent evidences of slope failure on the iandside south of the <br />dam (perform visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Notes: <br />Signature of Inspector: , c, <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 />