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Monument Dam <br /> Inspection Form <br /> Date: 11serI$ <br /> Time: M.se *v--.. <br /> Name of In Spector: Y►1'[ e.++c ac f�- <br /> Current Panel Being Mined: <br /> ❑ Weekly Inspection moTGIonthly Inspection <br /> Yes No <br /> ❑ CY" Is mining within 1 mile of Monument Dam? <br /> ❑ 2-' Are there visible surface cracks on the dam? <br /> If yes, indicate length and size of crack. <br /> ❑ p- Is there evidence of subsided areas on or around the dam? <br /> If yes, indicate where and degree. <br /> ❑ 0' Are there bulges on the dam? <br /> If yes, indicate where and degree. <br /> ❑ E ' Are there signs of seeps on the dam? <br /> If yes, indicate where and estimated flow. <br /> ❑ E�' Are there any other potentially damaging features on the dam? <br /> If yes, describe. <br /> ❑ [!r 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 /> 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 /> (WAMCC-Engineering\ENV PERMITCING\REG AGENCIES\CDRMS\Monument DarnWonument Dam Inspection Procedure\Monument Dam Inspection Form) <br />