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Monument Dam <br />Inspection Form <br />Date: 10 ! 24 /too <br />Time: 4'50 <br />Name of Inspector: VA% Ke. <br />Current Panel Being Mine 4: <br />❑ Weekly Inspection p"Monthly Inspection <br />Yes No <br />❑ d Is mining within I mile of Monument Dam? <br />■ rA <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 />❑ [al Are there bulges on the dam? <br />If yes, indicate where and degree. <br />❑ c3l Are there signs of seeps on the dam? <br />If yes, indicate where and estimated flow. <br />❑ CR/ <br />Are there any other potentially damaging features on the dam? <br />If yes, describe. <br />❑ C!( 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 \MCC-Engmeering\ENV PERNETTING\REG AGENCIMCDRMSMonumem DarnWonument Dam Inspection Procedure\Monument Dam Inspection Form) <br />