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Monument Dam <br /> Inspection Form <br /> Date: aj 111/19 <br /> Time: 12•.U p M <br /> Name of Inspector: M. Ve, <br /> Current Panel Being Mined: E 7 1Pone,L <br /> ❑ Weekly Inspection 1lo,'Monthly Inspection <br /> Yes No <br /> ❑ �� Is mining within 1 mile of Monument Dam? <br /> ❑ DKO' Are there visible surface cracks on the dam? <br /> If yes, indicate length and size of crack. <br /> ❑ 1r Is there evidence of subsided areas on or around the dam? <br /> If yes, indicate where and degree. <br /> ❑ 41-- Are there bulges on the dam? <br /> If yes, indicate where and degree. <br /> ❑ 9?1- Are there signs of seeps on the dam? <br /> If yes, indicate where and estimated flow. <br /> ❑ 15' 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: <br /> r <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 AMCC-Engineering\ENV PERMITTING\REG AGENCIEMDRMSWonument DamWonument Dam Inspection Procedure\Monument Dam Inspection Form) <br />