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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, Y =Inspected and Violations (NOV) or Cessation Order (C0) issued, B =Inspected and both Comments noted 8 Violations or Cessation Ur der issued, T = 10 Day Notice Issues 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 /Q/ R/ V / B / T / S LCJ SIGNS AND MARKERS ................. L Y / NA / N /®/ V / B / T / S ] LCJ ROADS ............................. L Y / NA / N /®/ V / B / T / S LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /~/ V / B / T / S J LCj BACKFILL 8 GRADING ................ L Y / NA / N/®/ V / B / T / S J LC] EXPLOSIVES ........................ L Y / NA ~/ R/ Y / B / T / S J L~:] PROCESSING WASTES ................. L Y / NA / N /®/ V / B / T / S J LCJ SUPPORT FACILITIES ................ L am/ NA / N / R / V / B / T / S J L~7 TOPSOIL ........................... L Y / NA / N / ®/ Y / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCE...... L~/ NA / N / R / V / B / T / S LCJ FISH & WILDLIFE ................... L Y / NA / N /~/ V / B / T / S LCJ REVEGETATION ...................... L Y / NA /CND/ R/ V / B / 7 / S J LCJ AIR RESOURCE PROTECTION........... L d/ NA / N / R / V / B / T / S 7 LCJ SLIDES 8 DAMAGE ................... L Y / NA / N/ R/ V / B / T / S J LCJ SUBSIDENCE ........................ L Y / NA / G/ R / V / B / T / S J LC1 EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y / N!1 / N ~y V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y / NA /~I / R / V / B / T / S J LCJ RECLAMATION SUCCESS ............... L Y / NA /~J / R / V / B / T / S J LCJ SPECIAL CATEGORIES OF MINING...... L Y / NA / N / R / V / B / T / S J (1) L20 (2) -------------------- Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - L(=J OTHERS ............................ L Y/ NA N/ R/ V/ B/ T J (1) L20 -------------------= (2) Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - N07E: lC1 =Required Entry.