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Monument Dam <br />Inspection Form <br />Date: #tgk? <br />Time: / -)- 9 �m <br />Name of Inspector: ` -�s�� e --tea <br />Current Panel Being Mined:�y r <br />❑ Weekly Inspection TyAVIonthly Inspection <br />Yes No <br />❑ ae'� Is mining within 1 mile of Monument Dam? <br />IF] <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 />© q/ 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: <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:\NICC-Engineering\ENV PERIMTTING\REG AGENCIES\CDRMS\Monument Dam\Monument Dam Inspection Procedure\Monument Dam Inspection Form) <br />