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Monument Dam <br />Inspection Form <br />Date: 11 lt$'11 <br />Time: I ; 3o (+v--- <br />Name <br />+vKName of Inspector: rvli <br />Current Panel Being Mined: <br />❑ Weekly Inspection Monthly Inspection <br />Yes No <br />❑ 2r" 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 />❑ Z' 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 />❑ d 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 />e of Inspector: <br />ector: p <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 PERMIITING\REG AGENCIEWDRMSWonument DamNonument Dem Inspection ProcedureWonument Dem Inspection Form) <br />