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Monument Dam <br />Inspection Form <br />Date: <br />Time: <br />Name of Inspector: 1110.4Coac <br />Current Panel Being Mined: 5 'e L_ p R T IoZP 9, <br />❑ Weekly Inspection P -Monthly Inspection <br />Yes No <br />❑ w-*' Is mining within 1 mile of Monument Dam? /VO <br />❑ ❑ Are there visible surface cracks on the dam? <br />If yes, indicate length and size of crack. <br />❑ ❑ <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 />❑ ❑ 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: � •tom � ��y�co�� <br />M-2� <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 PERMITI'ING\REG AGENCIESTDRMSWonument DarnWonument Dam Inspection ProoedureWonument Dam Inspection Form) <br />