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Monument Dam <br />Inspection Form <br />Date: 809A/ <br />Time: 1.3d <br />Name of Inspector: ZOt4.' -IC�c: cy <br />Current Panel Being Mined: (776iie -1 '��Y x e s� <br />❑ Weekly Inspection � Monthly Inspection <br />Yes No <br />❑ )?G <br />0 <br />El <br />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 />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: A <br />Signature of Inspector: <br />Inspections are performed under the direction of Jessica Loveland, P. K <br />-If cracks or other potentially damaging features occur, notify Jessica Loveland <br />immediately. <br />