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<br />~ <br />..,~.. <br />i <br />• <br />_ <br />• <br />STATE OF <br />_ <br /> <br />COLORP~DO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmem of Natural Resources <br />1713 Sherman Sr., Raom 215 <br /> <br />Denver, Colorado B020J I~~ <br />Phone: (3031 866-3567 AVS Annual Review <br />FAX: (7071 832-8106 Inspection Worksheet <br />DEPAR <br />Date ~ ,~f l(~ 1598 RESC <br />Mine Name/Permit Number e sid trI`I ~y ~Sa4-~i /~ <br />I"9 t <br />'~l c'/S ~`~e Roy Romer <br /> ~iOVefrl°f <br />Ins ector Si nature <br />p g lame: s. r° <br />Czec°live C <br /> <br />Based on your on-site observatio <br />n, please answer the following: Michael 8. I <br />olvislo~ o.. <br />1) Mine ID sign <br />a) Permittee q,~(,JG~Lc°f'~fjrYl l~_~a,~.r j~ X <br />b) Operator ~6 u7Gt'U"1~,~ n~ ~_~ ~~'''/Da' ~ / <br />c) MSHA ID .~ (not required to be on sign) <br />2) Direct inquiry (of persons one the s/ite)~ /'°" / <br />a) Permittee //QSC~-t~//~i8~n c..~L( G~~°"~~~ <br />b) Operator / IWb~ p~ pin ~ ~~*a/-rc' f <br />c) MSIiA iD (.•TC. aP•e~./r'ae/~ <br />_41`4 Pp. /u/, cP°OSrYJ~~~ <br />3) Is.ownership/control information for permittee and op for noted in field consistent with <br />what is listed in the permit 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 [he permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions). Annualy as long as coal e:ctraction <br />from [he site has not been completed, DMG must determine whether officer/controller information is <br />complete and accurate in AVS. In making the determination of complete and accuratdnformation, on-site <br />observations and direct inquiry of persons on the site is necessary. The information on this form will be <br />verified with AML, MSHA, and ElA information in AVS. Please return the form to Erica Crosby to be <br />verified in the AVS. <br />c: \esc\avs\a n n ua I <br />