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.... <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmenl of Natural Resources <br />13 i 3 Sherman St., Room 2 i 5 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (3031 832-x106 <br />Date _( .2 9 <br />AVS Auuual Review <br />Inspection Worksheet <br />Mine Name/Permit Number I'11~ C(o..a e Cgy~p,,, ~%~/ e C-8'~ -~ ~ <br />Inspector Signature <br />Based on your ON-SITE Observation, please answer the following: <br />I) Mine ID sign <br />a) <br />b) <br />c) <br />Permittee Loci P_,5' IAN C.~rq rti , j. ~r G . <br />Operator Goc%,S ~t?r ~rlc/'q y~l.`c . <br />MSHA ID <br />(not required to be on sign) <br />2) Direct inquiry (of persons /on the site) <br />a) Permittee LBC%s~r ~ienvy~Z'~7c, <br />b) Operator L~e.t'~~ ~~e/~;Gg~SF,,r-fC <br />e) MSHAID DSO3a<3 <br />~DI VISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SAFETY, <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Enecmive Director <br />Michael B. Long <br />Division Direc~or <br />3) Is ownership/control information for Permittee and rator noted in field consistent with <br />what is listed in the person 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 the permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions). Annually as long as coal <br />extraction from the site has not been completed, DMG must determine whether officer/controller <br />information is complete and accurate in AVS. In making the determination of complete and accurate <br />information, on-site observations and direct inquiry of persons on [he site is necessary. The information <br />on this form will be verified with AML, MSHA, and EIA information in AVS. Please return the form to <br />Johanna Cramer to be verified in the AVS. <br />