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Monument Dam <br />Inspection Form <br />Date: <br />Time: <br />Name of Inspector: &vimaCC"C;1 <br />Current Panel Being Mined: FS )(' � c L1 f <br />❑ Weekly Inspection G1 Monthly Inspection <br />Yes No <br />❑ [a 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 />❑ C7 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 />❑ ❑i 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 />r`JSi16%C 1.1; a fv /aG �Y <br />Signature of Inspector: <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 />