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R. For The Following Entries, Circle The Appropriate Choice: = nspec a an oun to comp lance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, V =Inspected and Violations (NOV) or Cessation Order (CO) issued, B =Inspected and both Comments noted 8 Violations or Cessation Order issued, T = 10 Day Notice Issued by OSM Oversight Personnel, S =Sample taken and sent to the lab from analysis - describe type and location of sample taken under comment section. GENERAL INSPECTION TOPICS: CORDS........... L Y / NA /(~/ R / V / B / T / 5 7 LCJ SIGNS AND MARKERS ................. L Y / NA / N / 6 / Y / B / T / S 7 LCJ ROADS ............................. L Y / NA / N / ~j / V / B / T / S ] LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /~/ V / B / T / S LCJ BACKFILL & GRADING ................ L Y / ~/ N / R / V / B / 7 / S J LC] EXPLOSIVES ........................ L Y / N / N / R / V / B / T / S J Lr.] PROCESSING WASTES ................. L Y / ~ / N / R / V / B / T / S J LC] SUPPORT FACILITIES ................ L YO/ NA / N / R / V / B / T / S LCJ TOPSOIL ........................... L Y / NA /~ R / V / B / T / S LC] GENERAL MINE PLAN COMPLIANCE....,. L Q/ NA / N / R / V / B / T / S J LCJ FISH & WILDLIFE ................... L Y / NA /~ / R / V / B / T / S J LCJ REYEGETATION ...................... l am/ NA / N / R / V / B / T / S J LCJ AIR RESOURCE PROTECTION........... LCD/ NA / N / R / V / B / T / S LCJ SLIDES & DAMAGE ................... L Y / ®/ N / R / V / B / T / S ] LC] SUBSIDENCE ........................ L Y / N~ / N / R / V / B / T / S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y / ~ / N / R / V / B / T / S LCJ OFFSITE SUPPORT FACILITIES........ L Y /~ 1 N / R 1 V / B / T 1 S J LCJ RECLAMATION SUCCESS ............... L Y / ~ / N / R / V / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... L Y / J~/ N / R / V / B / T / S J (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ l~ / N/ R/ V/ B/ T J (1) L20 - - - - - - - - - - - - - - - - - - - - (2) Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.