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Monument Dam <br />Inspection Form <br />Date: <br />Time: 16),'60 <br />Name of Inspector: <br />Current Panel Being Mined: ES - &J V_ e <br />❑ Weekly Inspection,'Monthly Inspection <br />Yes No <br />El li� <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />C <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 (perform visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Notes: Qawt /j /V/ <br />1_1111w';h'11-. <br />Signature of Inspector: e z <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 />