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Monument Dam <br />Inspection Form <br />Date: /O/z'//�' <br />Time: y� `i )�� <br />Name of Inspector: <br />Current Panel Being Mined: <br />❑ Weekly Inspection -'Monthly Inspection <br />Yes No <br />❑ W' Is mining within 1 mile of Monument Dam? <br />❑ I Are there visible surface cracks on the dam? <br />If yes, indicate length and size of crack. <br />❑ x <br />❑ hs <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: <br />Signature of Inspector: J <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 />