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Monument Dam <br />Inspection Form <br />Date: j1 /�Sliy <br />Time: <br />Name of Inspector: <br />Current Panel Being Mined: 4S,t'e <br />❑ Weekly Inspection CK Monthly Inspection <br />Yes No <br />El <br />70 <br />C <br />❑ ❑ <br />0 <br />Is mining within 1 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 />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 (perfonn visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Notes: <br />('zb� -' <br />Signature of Inspector: z' IL -7 e <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 />