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For The Following Entries, Circle The Appropriate Choice: = nspec e an oun to Comp Lance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, Y =Inspected and Violations (NOV) dr Cessation Order (CO) issued, B =Inspected and both Comments noted 8 Violations or Cessation Order issued, T = 10 Day Notice Issued I>y 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 / S ] LC] SIGNS AND MARKERS ................. L NA ~ / N /®/ Y / B / T / S ] LCJ ROADS ............................. L Y / NA / N / ®/ V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /®/ V / B / T / S ] LCJ BACKFILL 8 GRADING ................ L Y / NA !! \\ /UY/ R / V / B / T / S ] LCJ EXPLOSIVES ........................ L Y / ~/ N/ R / V / B / T / S j LCJ PROCESSING WASTES ................. L Y / ~/ N / R / V / B / T / S ] lC] SUPPORT FACILITIES ................ L Y / NA / ~/ R / V / B / T / S ] LC] TOPSOIL ........................... L Y / NA / ~/ R / V / B / T / S J LC] GENERAL MINE PLAN COMPLIANCE...... L Y / NA / ®/ R / V / B / T / S ] LCJ FISH 8 WILDLIFE ................... L CYO/ NA / N / R / V / B / T / S ] LC] REVEGETATION ...................... L Y / NA /((~/ R / V / B / T / S ] LCJ AIR RESOURCE PROTECTION........... L Y / NA / ®/ R / V / B / T / S ] LCJ SLIDES 8 DAMAGE ................... L Y / NA /~AV/ R / V / B / T / S ] LC] SUBSIDENCE ........................ L Y / NA /~/ R / V / B / T / S ] LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y / ~ / N / R / V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y J NA !~ J R 1 V ! B ! T / S ] LCJ RECLAMATION SUCCESS ............... L Y / NA / ®/ R / V / B / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... L Y / ~/ N / R / V / B / T / S ] (1) ------------------- L20 (2) Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y / fJA / N / R / Y / B / T ] (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.