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• r 9s9 <br />i7 <br />•a <br />R ^ ~ ~ i ` „_ ,1 ~ I Pepe 1 or t Pages <br />United States Department of the Interior~T 15 1991 For Office Use Only <br />Office of Surface Mining ~ <br /> <br />Mine Site Evaluation Inspection <br />Report <br />ned L ,a ,b ,p <br /> and, <br />Reclamation pi <br />~ <br /> ~ ~V Y M M aatcn Report <br />.. <br />2. Name of Permittee <br />9. MSHA Number 10. Date of Inspection <br />(Y Y M M D D) <br /> <br />~ <br />, <br /><~ ~ ,l ;i <br />>' ~ <br />4 - . <br />t.~ <br />;~ - In~r r <br />3. SVeel Atldre55 > ~ 11. Stale Permit Num <br />ber <br />i <br /> _ <br />~7~ <br />l~ <br /> 4. City 5. Stale 72. Name of Mine <br /> <br />6. Zlp ode 7. Area Code 8. Telephone Numb, ~ 13. County Code 14. Stale Cody 75mStrata I16~State Aroa Office <br /> <br />17. OSM Field 18. OSM Area 19. OSM 20. Type of Inspectior. 27. Joint Insp n 22 Inspector's ID <br />Ofllce No. Oefllce No. Sample~No. <br />lII„ IIIT_~11 (Code des N <br />~ Np. <br />I~ff' IT~ I ll ~I <br />23. Slatus 24. Type of Activity (c!teCk applicable Cowes). <br />A m Type ~oF Permil <br />A Sleep Slope <br />E ~ Anthrar~te <br />B ~ Mine Slatus (Code) <br />B ~ Mountain Top Rertioval <br />F L Federal Lands <br />® <br />C Type of Facillly (Code) <br />~ <br />C ~ Prime Farmlands <br />G I-I Indian Lands <br />L~ <br />~, <br />D 17Li1-!.Z_LL-I(LLJ.].J Number or Pelmitted Acres D ~ Alluvial Valley Floors H ~ Other <br />E ~ n r • Number of Disturbed Acres <br />25. Performance Standards ICodesl <br />InalruNbn•: Intlicete compliance code..FOr any Standard marked 2 or 3 provide narrative to support this determination. <br />Standards Thal Limit the Ellacts to the Permil Area Standards Tnat Assu•e Reclamation Oualily and Timeliness <br />A ~ Distance F•rohlbilions M ~ TODSOiI Handling <br />B ~ Mining Within Permit Boundaries N n Back!ill~r~g aria Grading <br />L <br />~J <br />C ~ Signs and Markers Following ReclamaLOn ScLednle <br />O <br />i! <br />J <br />D n Setllment Control Measures P <br />n <br />Reveyelatinn Reouiremenls <br />~[ <br />J <br />E ~ Design antl Cerlltlcatlon ReQuilemenl9- l <br />l <br />Disposal of Excess Spoil <br />O <br />l / I <br />`!-' <br />Sediment Control R n Handling of Acid or Toxic Materials <br />J <br />F ~ Effluent Llmlts u <br /> <br />G ~ Surface Water Monitoring S Hlghwall Elimination <br /> <br />H n Ground Water Monitoring T Downslope Spoil Disposal <br />- <br /> <br />4--~ ~ <br />-l <br />U I / I Post Mining Land Use <br />r <br />1 <br />I I ' I Blasting Procedures <br />Y-~ '~I--' <br />V n Cessation of Operations: Temporary <br />J <br />J ~ Haul/Access Road Design and Maintenance v- <br />W ~ Other _____ __ _. <br />K .~ Relusa Impoundments <br />L ~ Other; Specify ! <br />I <br />I <br />Distribution: Original - Fieltl Office, Green ~ Headquarters, Blue ~ Slate's Copy, Yellow ~ Inspector's Copy. Pink ~ File Copy IE ~ 163 (1163) <br />