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Monument Dam <br /> Inspection Form <br /> Date: 10(24 1100 <br /> Time: 4"10 <br /> Name of Inspector: IrA'% 1(f, <br /> Current Panel Being Mine : �� <br /> ❑ Weekly Inspection Monthly Inspection <br /> Yes No <br /> ❑ d Is mining within 1 mile of Monument Dam? <br /> ❑ ICY Are there visible surface cracks on the dam? <br /> If yes, indicate length and size of crack. <br /> ❑ We Is there evidence of subsided areas on or around the dam? <br /> If yes, indicate where and degree. <br /> [7 l Are there bulges on the dam? <br /> If yes, indicate where and degree. <br /> ❑ d 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: <br /> Signature of Inspector: �b� <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 PERNUTTING\REG AGENCIES\CDRMS\Monument Dam\Monument Dam Inspection Procedure\Monument Dam Inspection Form) <br />