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Monument Dam <br />Inspection Form <br />Date: 0 '�? 1 b' � 17 <br />Time: �2. ' - -30 P-111— <br />Name of Inspector: - 2'� <br />Current Panel Being Mined: <br />❑ Weekly Inspection &1Vlonthly Inspection <br />Yes No <br />❑ Is mining within 1 mile of Monument Dam? <br />0 <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 />C■J <br />Are there any other potentially damaging features on the dam? <br />If yes, describe. <br />❑ C� 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: 11 <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 WC-EngineenngEW PERMITTING\REG AGENCIESTDRMSWonument DarnWonument Dam Inspection Procedur6Monument Dam Inspection Form) <br />