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Monument Dam <br />Inspection Form <br />Date: 1/181 <br />Time: S.TV0 PO"7 <br />Name of Inspector:? �, <br />Current Panel Being Mined: .'6 Ph-, 4tCx - <br />❑ Weekly Inspection Od Monthly Inspection <br />Yes No <br />❑ �4 Is mining within 1 mile of Monument Dam? <br />❑ r� Are there visible surface cracks on the dam? <br />1 If yes, indicate length and size of crack. <br />[-i f Is there evidence of subsided areas on or around the dam? <br />J If yes, indicate where and degree. <br />Li Are there bulges on the dam? <br />If yes, indicate where and degree. <br />0 <br />11 <br />A <br />Notes: <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 />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:\MCC-Engineering\ENV PERMITTING\REG AGENCIES\CDRMS\Monument Dam\Monument Dam Inspection Procedure\Monument Dam Inspection Form) <br />