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Monument Dam <br /> Inspection Form <br /> Date: $j 27 f Zol 9 <br /> Time: ;'00 p r\ <br /> Name of Inspector: RA V <br /> Current Panel Being Mined: Uw�9 <br /> ❑ Weekly Inspection a Monthly Inspection <br /> Yes No <br /> ❑ & Is mining within I mile of Monument Dam? <br /> C 14 Are there visible surface cracks on the dam? <br /> If yes, indicate length and size of crack. <br /> ❑ M1 Is there evidence of subsided areas on or around the dam? <br /> If yes, indicate where and degree. , <br /> ❑ E� 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 /> ❑ K 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: /V <br /> Inspections are performed under the direction of John Poulos, P.E. <br /> If cracks or other potentially damaging features occur, notify John Poulos or Kathy Welt <br /> immediately. <br /> (WAMCC-Engineering\ENV PERMITTINGREG AGENCIESTDRNIMMonument Dam\Monument Dam Inspection Procedure\Monument Dam Inspection Form) <br />