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Monument Dam <br />Inspection Form <br />Date: 1111117 <br />1/' <br />Time: 3:0p/; '�.�� <br />Name of Ins ector: ///� <br />Current Panel Being Mined: .-6 pe""Z I <br />❑ Weekly Inspection 0 Monthly Inspection <br />Yes No <br />El <br />❑ ❑ <br />El <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 the 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 />F <br />Notes: tip <br />Signature of Inspecto <br />Inspections are performed under the direction of Mike Peacock, P. E. <br />If cracks or other potentially damaging features occur, notify Mike Peacock or Kathy <br />Welt immediately. <br />(W WCC-Engineenng\ENV PERMITTING\REG AGENCIES\CDRMS\Monument Dam\Monument Daze Inspection Procedure\Monument Dam Inspection Form) <br />