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Monument Dam <br />Inspection Form <br />Date: ' % i <br />Name of Inspector: C <br />Current Panel Being Mined: <br />❑ Weekly Inspection © Monthly Inspection <br />Yes No <br />❑ © Is mining within I mile of Monument Dam? <br />❑ ❑ Are there visible surface cracks on the dam? <br />El <br />l <br />❑� <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 />❑ 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 />i <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 />