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STATE OF <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmenl of Natural Resources <br />1313 Sherman Sl., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: 1703)832-8106 <br />Date ~~ ,3 7 <br />AVS Anuual Review <br />Inspection Worksheet <br />iii iiiiiiiiiiiii iii <br />999 <br />COLORADO <br />MineName/PermitNumber 7 uvt rr /y/r~r ~-~~-Oaf <br />Inspector Signature ` <br />Based on your ON-SITE Observation, p ease answer the following: <br />I) Mine ID sign <br />a) Permittee Lodes f ~~ F-herg y, Zyc . <br />b) Operator Lodesf¢i~~er9 y, T-*c. <br />~- <br />c) MSHA ID (not required to be on sign) <br />2) Direct inquiry (of persons on th/e site) <br />a) Permittee Le~(ert7ra' ,~H Ery 4 ,T,., c , <br />b) Operator G°~/e.r7~2~ E-~ewj/,~~, Z~c, <br />c) MSHA ID ~ s O 3 /~ <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Bill ovens <br />Governor <br />Greg E. Walther <br />Executive Dueclor <br />rvtichael B. Long <br />Division Director <br />3) Is ownership/control information for perTnittee and o erator noted in field consistent with <br />what is listed in the person application? Yes !~ No <br />If No, what is in conflict? <br />DMG is required to verify this information as specified in the AVS MOU if the permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions). Annually as long as coal <br />extraction from the site has not been completed, DMG must determine whether of{cer/controller <br />information is complete and accurate in AVS. In lrtaking the determination of complete and accurate <br />information, on-site observations and direct inquiry of persons on the site is necessary. The information <br />on this form will be verified with AML, MSHA, and E[A information inn AVS. Please return the form to <br />Johanna Cramer to be verified in the AVS. <br />