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For The Following Entries, Circle The Appropriate Choice: = nspec a an oun in comp ance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, V =Inspected and Violations (NOV) or Cessation Order (CO) issued, B =Inspected and both Comments noted & 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 ~ R / Y / 8 / T / S LCJ SIGNS AND MARKERS ................. L f~/ NA / N / R / V / B / T / S ] LCJ ROADS ............................. 1 Y / NA / N / ® / V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N / ~/ V / B / T / S LCJ BACKFILL & GRADING ................ L Y / NA / N / ~/ V / B / T / S J lC] EXPLOSIVES ........................ L Y / NA / ~ / R / V / B / T / S j LCJ PROCESSING WASTES ................. L Y / A/ N / R / V / B / T / S LCJ SUPPORT FACILITIES ................ L Y / A / N / R / V / B / T / S 7 LCJ TOPSOIL ........................... L Y / NA / N / ~ / V / B / T / S LC] GENERAL MINE PLAN COMPLIANCE,,,.,. L Y / ~ / N / R / Y / B / T / S LCJ FISH & WILDLIFE ................... L Y / NA / J~/ R / V / B / T / S J LCJ REVEGETATION ...................... L Y / NA / N /®/ V / B / T / S J LCJ AIR RESOURCE PROTECTION........... L Y / At~ / N / R / V / B / T / S J LCJ SLIDES & DAMAGE ................... L Y / NA / ~ / R / V / 8 / T / S LCJ SUBSIDENCE ........................ L Y / NA / N/ R / V / B / T / S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y / NA / N / R / Y / 8 / T / S LCJ OFFSITE SUPPORT FACILITIES........ L Y / NA / N R '/ Y / B / T / S LCJ RECLAMATION SUCCESS ............... L Y / NA / N / R / V / B / T / S J LCJ SPECIAL CATEGORIES OF MINING...... L Y " V / N / R / V / B / T / S J (1) L20 (2) -------------------- Spaces (3) -------------=------ Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ NA / N/ R/ V/ B/ T J (1) L20 (2) -------------------- Spaces (3) -------------------- Max) - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.