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Monument Dam <br />Inspection Form <br />Date: i1�-qll <br />Time: '�', IS ►'�— <br />Name of Inspector:_�e,A L &K' - <br />Current Panel Being Mined: E —7 -Pc�.0 xcl S.5 <br />❑ Weekly Inspection 'Monthly 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 />❑ ❑ <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: --k <br />Signature of Inspector: r <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 PERAUTTTNG\REG AGENCIES\CDRMS\Monument Darn\Monument Dam Inspection Procedure\Monument Dam Inspection Form) <br />