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Monument Dam <br /> Inspection Form <br /> Date: /a <br /> Time: /.a rv\ <br /> Name of Inspector: Nike .4c oG1C <br /> Current Panel Being Mined: 5 ctPe, ',)q A R 7 <br /> ❑ Weekly Inspection P- Monthly Inspection <br /> Yes No <br /> ❑ Ep� Is mining within 1 mile of Monument Dam? A10 <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 /> ❑ ❑ Are there bulges on the dam? <br /> If yes, indicate where and degree. <br /> ❑ 0 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: OM6"�'� ��W <br /> W4 <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 AGENCIES\CDRMS\Monument DamWlonument Dam Inspection Procedure\Monument Dam Inspection Form) <br />