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1. n For The Following Entries, Circle The Appropriate Choice: = nspec a an oun in comp lance, NA = Inspection Topic not applicable, N = Not Inspected, R = Inspected and comments noted, Y =Inspected and Violations (NOV) or Cessation Order (CO) issued, B = Inspected and both Comments noted 8 Violations or Cessation Order issued, T 10 Day Notice Issued 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 / ~l / R / V / B / T / S LCJ SIGNS AND MARKERS ................. l Y / NA / ®/ R / V / 6 / T / S J LCJ ROADS ............................. L Y / NA / ®/ R / V / B / T 1 S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N / ~/ V / B / T / S J LCJ BACKFILL 8 GRADING ................ L ~' / NA / N / R / V / B / T / 5 LCJ EXPLOSIVES ........................ L Y / dA / N/ R / V / B / T / 5 J LCJ PROCESSING WASTES ................. L Y / I® / N / R / Y / B / T / S J LCJ SUPPORT FACILITIES ................ L Y / NA / ~/ R / V ! B ! T / S J LCJ TOPSOIL ........................... L Y / NA / ri(~/ R / V / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCE...... L (~/ NA / N / R / V / B / T / S J LCJ FISH 8 WILDLIFE ................... L Y / NA / ~/ R / V / B / T / S LCJ REVEGETATION ...................... L Y / NA /t~/ R / V / B / T / S LCJ AIR RESOURCE PROTECTION........... L Y 1 !~ / N 1 R / V ! B / T / S J LCJ SLIDES 8 DAMAGE ................... l Y / ~ / N / R / V / B / T / S LCJ SUBSIDENCE ........................ L Y / NA / ®/ R / V / B / T / S J LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y / NAj / N / R / V / B / T / S J LCJ OFFSITE SUPPORT FACILITIES........ L Y / NA / ®/ R / V / B / T / 5 J LCJ RECLAMATION SUCCESS ............... L Y / NA /'{,)/ R / V / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... L Y / ~ / N / R / V / B / T / S J (1) L20 (2) - - - - - - - - - - - - - - - - - ------ Spaces (3) -------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ NA / N/ R/ V/ B/ T J il) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.