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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />AVS Annual Review <br />Inspection Worksheet <br />Date q / / / % y <br />Mine Name/Permit Number Mew t"1o''f W(I / /1b r "OD$ <br />Inspector Signature �G <br />Based on your ON -SITE Observation, please answer the following: <br />1) Mine ID sign <br />a) Permittee kl eSf? f K Fke�15 6?!o rctde>) L L C <br />b) Operator <br />C) MSHA ID <br />S4 hq <br />2) Direct inquiry (of persons on the site) <br />(not required to be on sign) <br />a) Permittee h- e—S i;e/"t, Fytl s CU ror4 dD l LC(- <br />b) Operator � a h'%-e_ <br />C) MSHA ID <br />COLORADO <br />D IV IS I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />3) Is ownership /control information for permittee and perator noted in field consistent with <br />what is listed in the permit application? Yes No <br />If No, what is in conflict? <br />DRMS is required to verify this information as specified in the AVS MOU if the permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions). Annually as long as coal <br />extraction from the site has not been completed, DRMS must determine whether officer /controller <br />information is complete and accurate in AVS. In making the determination of complete and accurate <br />information, on -site observations and direct inquiry of persons on the site is necessary. The information <br />on this form will be verified with AML, MSHA, and EIA information in AVS. Please return the form to <br />Mary Rodriguez to be verified in AVS. <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />