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Monument Dam <br />Inspection Form <br />Date: <br />Time: 10 -'00iZ <br />Name of Inspector: vua_� <br />Current Panel Being Mined: C`/ XC31 <br />❑ Weekly Inspection 0 Monthly Inspection <br />Yes No <br />❑ 'q 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 />❑ l ❑ Is there evidence of subsided areas on or around dam? <br />\ If yes, indicate where and degree. <br />❑ ❑J Are there bulges on the dam? <br />If yes, indicate where and degree. <br />❑ ( ❑ Are there signs of seeps on the dam? <br />l If yes, indicate where and estimated flow. <br />❑ J❑ 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: (J.�o - � <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 />