2015-07-06_REPORT - C1980007

• Permit No: C1980007
• IBM Index Class Name: Report
• Doc Date: 7/6/2015
• Doc Name: 1st Quarter 2015 Subsidence Observation
• From: Mountain Coal Company
• To: DRMS
• Annual Report Year: 2015
• Report Quarter_Month: 1
• Permit Index Doc Type: Subsidence Report
• Email Name: JRS
• Email Name: MPB
• Media Type: D
• Archive: No

Forest Service Roads
Inspection Form
Date: //.2,�, //,5-
Time: 9,-,,3,,)
Name of Inspector:
Current Panel and XC Being Mined
Road(s) Being Inspected: /
Yes No
S kd &0 t
❑J Is the Forest Service road within the projected angle of draw of
subsidence? If yes, which road(s):
❑ ❑ Are there visible surface cracks on the road? If yes, describe
(location, width, length, etc.):
❑ ❑ Is there any recent evidence of potential subsidence induced slope
failure? If yes, describe:
El ❑ Are there any other potentially damaging, subsidence induced
features on or near the road? If yes, describe:
❑ ❑ Is mitigation needed? If yes, list suggestions:
Notes:
1(,W'f are
c1 )6k) -
L�spe� UnJ
106`/
9,nd1hr1nJ IA/10
Signature of Inspector: 7
* If any potential subsidence induced features are observed that could cause harm
to the public or operations, notify Jessica Loveland or Mike Peacock immediately.