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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, 4 =Inspected and Viol ati ons (~OV) or Cessation Order (CO) issued, B =Inspected and both Co mments noted 8 Violations or Cessation Order issued, T = 10 Day Notice Issu ed by OSM Overs igh t Personnel, S =Sample taken and s ent to the lab from anal ysis - describe type ana location of sample taken un der comment section. GENERAL INSPECTION TOPICS: CORDS........... L Y/ NA /~/ R / V / B / T / S J LCJ SIGNS AND MARKERS ................. L Y / NA ! N !® / V 1 8 / T / S LCJ ROADS ............................. L~/ NA / N / R / V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /® / V / 8 / T / S LCJ BACKFILL 8 GRADING ................ L Y/ NA /~/ R / V / B / T / S l LC] EXPLOSIVES ........................ L Y /~ / N/ R / V / B / T / S LCJ PROCESSING WASTES ................. L Y! NA / N 1 R / V / B / T / S LCJ SUPPORT FACILITIES ................ L Y ~/ N/ R / V / B / T / S J LCJ TOPSOIL ........................... L~/ NA / N / R / V / B / T / S J LC] GENERAL MINE PLAN COMPLIANCE...... L Y ! NA / NO/ R / V / B ! T ! S J LCJ FISH 8 WILDLIFE ................... LOY / NA / N / R / V / B / T / S J LCJ REVEGETATION ...................... L Y/ NA / N /~/ V / B / T / S J LCJ AIR RESOURCE PROTECTION........... L Y /~/ N/ R / V / B / T / S J LCJ SLIDES 8 DAMAGE ................... L Y/ NA / N/ R / V / B / T / S J LCJ SUBSIDENCE ........................ L Y/ NA /~! R / V / B / T / S J LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y /~ / N / R / V / B / T / S LCJ OFFSITE SUPPORT FACILITIES........ L Y /~/ N/ R / V / B / T / S J LCJ RECLAMATION SUCCESS ............... LO / NA / N / R / V / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... L Y / NA / N / R / V / B / T / S (2) -------------------- L20 Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ NA N/ R/ V/ B/ T J (2j -------------------- L20 _________________ Spaces (3) -------------------- MaxJ NOTE: LCJ Required Entry.