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Monument Dam <br />Inspection Form <br />Date: 2%T /( Z; <br />Time: 1 .3a <br />Name of Inspector: Xt 44 �:Rk,� <br />Current Panel Being Mined: E7 1 I y1c .32 <br />❑ Weekly Inspection &,Vonthly Inspection <br />Yes No <br />:1 pr""' Is mining within 1 mile of Monument Dam? <br />❑ ❑ <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 />❑ ❑ <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:Ta.,rj d/� _/u <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 PERNETTING\REG AGENCIES\CDRMS\Monument Dam\Monument Dam Inspection Procedure\Monument Dam Inspection Form) <br />