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Monument Dam <br />Inspection Form <br />Date: 'A19 /1'7 <br />Time: 9 : o o P,; -w - <br />Name of Inspector: <br />Current Panel Being Mined: <br />❑ Weekly Inspection 91-K�onthly Inspection <br />Yes No <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 />❑ �i 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 � f <br />Signature of Inspector: <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 />(WAMCC-Engineering\ENV PERMITTING\REG AGENCIESTDRMSNonument Dam\Monument Dam Inspection Procedurc\Monument Dam Inspection Forth) <br />