INSPEC04523

• Permit No: C1981047
• IBM Index Class Name: Inspection
• Doc Name: OSM MINE SITE EVALUATION INSPECTION REPORT
• Media Type: D
• Archive: No

- ~ Unitt?~tates Department of the Interior •
- Office of Surface Mining
Mine Site Evaluation Inspection Report
26. State Permlt Number 27. Date of Inspection
(YYM MDD)
;~ / :! is i / v

26. Yes No Do mining and reclamation activities on the site comply with the plans In the Dermit?
Q ^ If no, rovlde narrative to su p ort this determination.
29. Indicate number of complete and parllal inspections conductetl by the State to date for this annual review period:
29a. ~ Number of Completes 29b. ,} /, Number of Partials
30. Indicate number of complete end partial Inspections required by the State during this annual review period: i~ ~~
308. ~, _, Number of Completes r 30b. ~ Number of Partials ./~ , ; - / ;~ ./ .
31. Has inspection frequency been met?
Yes No Yes No
31a. `a ^ Completes 31 b. ;: ^ Partials
32. FED ERAL ENFORCEMENT INFORMATION. [Enter violation number. Check appropriate box(es)?
Ten-Day Notice No. Nonce of Violation No. Cessation Order No. Violation Codes

A ^
^ ~~~
^ Authorizations to Operate
B ^ ^ ^ Signs end Markers
C ^ ^ ^ Backfilling and Grading
D ^ ^ ^ Hlghwall Elimination
E ^ ..................... ^ ....... .............. ^ ........................ Rills end Gullies
F ^ ~ ^ Improper Fills
G ^ ..................... ^ ^ ToPSOiI Handling
H ^ ^ ^ Sediment Ponds
I ^ ^ ^ Effluent Limits
J ^ ^ ^ ........................ Water Monitoring
K ^ ^ ^ ........................ Butler Zones
L ^ ..................... ^ ....... .............. ^ ........................ Roads
M ^ ..................... ^ ....... .............. ^ ........................ Dams
N ^ ..................... ^ ^ Blasting
O ^ ..................... ^ ^ Revegetation
P ^ ^ ^ Spoil on the Downslope
O ^ ^ ^ Mining Without Permit
R ^ ^ ^ Exceeding Permlt Limits
S ^ ^ ^ Distance Prohibitions
T ^ ^ ^ Toxic Materials
U ^ ^ ^ Other Violations
33. Name of Authorized Representative (print or type)

S f / ~~
ignatu re o
Autttprized Representative Date !.~

Signatu re, of Reviewing Official C! ~ Date ! o~ ~ ,~
~
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(
Olslrlbullon: Original - Fleltl Oflice, Green - Hoeepuarters, Blue -Stole's Copy, Vellow ~ Inspecloi s Copy, Pink ~ File Copy IE - 16311183)
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