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r ~- -~- _ ~_ _..~ :~-_-o- _:::.:.•_:..~~c~ ~ ~~~~c~~ ~ . 011 ~10~1~~1~000~010 <br />f 7IITY ~ti <br />1 <br />:ND <br />•.8)niY~d S4a4os:~eepar4menY 0Y 1~® ~~~ "'~ <br />~~ a^'~. For Office Use Only • :. <br />_ <br />p <br />p <br />~ <br />~ ~ . ~OYfICe 04 $UPYBC~ ~If11T roo~ olvlslo ~ <br />' .. I <br />_ - <br />- . + <br />=- -. - .-• Miine Sf4e Evatua4ion lnspec4ion Repoli -~ ~ to ~ . <br />. = ~ ~ 1b tc <br />' - - - - ' ' - _ Y Y M M . Boren rbpon <br />- ~ - _ - ~ ~ ~ <br />- ~ ~ ~ 10. Date of Inspection <br />2. Nama ol4brmlttp .~. ~ s - ' "`-r°.: ` - ~ ~ <br />~ ~ - 9. MSHA Number (Y Y M M O D) <br /> <br />'3. Strsat Addroaa ~ ~ - ~'`" ~~`' "-' _ ~ 't 1. State PormN Number . - - ~ -- ~ ~ - <br /> <br />i -0. Cit _ ~ ~ 5. State. ~ 1Z. Name of Mine - <br /> <br /> _ :- <br />~ <br />`3.21p Code- •' , r ~ •` 7. Arse Dodo ~, ~ A. Telephone Nombort =: ~' 13: County Code ta. Slate Code :: ,:, • 75. Strato , r 16. State Area Ofllce ' <br />- ~ -~ ~_ i_ <br /> <br />=17 DSM flaldf'- :-1B. OSM Arad r._~;: 19. OSM ~=_~' ~ •;,: -- <br />l 20. TYPO of.msPechon.;.~.S1..Joint Inspection-;::. -.: 22,.Inspectora ID . ~+: <br />y ' ~ ~.-0Hlca ko. - -, .Otllca No.'s - - SamDls No.-. _ _ ~C <br />O <br />de) <br />-.; .... Yas . <br />_ - <br />Nno. -. No.~. _ ~- <br /> '1 <br />,It <br />~~~ ~ ~ ~ , ~ <br />~ <br />b <br />~ <br />Zi.~Stntue•=~..: - - -'`-• +. ~ ~- _ 21. Type of Anirily._Icheck applicable coxes).: 1~ . _ - <br />, <br /> <br />~us~ _ __ -s <br />n .li_ tsa t ll. t~.~ - _ _ _ _ ._TYPB of ~ormit ~ . _, ~ ~. - <br />' <br />' _ ~.. •_ . ~~- :::_ ,z. _ R _. - _ <br />^c <br />...-:~±..~r.,'.~...SIeeO~S10P? `1 i _ ~''~ .i. J i '. _ <br />• <br />, <br />:Alne Status lCdde):`y _ . _ _ <br />. __ _:r_~=- _ <br />~: ' ^-8'~ ~.~ <br />~_ _ '•-~~-~ ~ ~ ~ •• "- '-' _ <br />• _ ,.... _ ,; :'.: <br />.? , <br />:L . ~. _ <br />: 8~ <br />~ 'Mountain TOP Removal's. = <br />. .-.,. r_, .._ <br />i <br />F <br />~ <br />l <br />i <br /> <br />. ~ -~ LL±'Type of ~Faelllty (Code) _• <br />- ~~ ~ .. <br />^, <br />. ~~_ _._._ .-Y; ~.: .. ::+ <br />' <br />N .. ~ <br />: F <br />dere <br />ntls <br />L <br />.: .-. ; <br />. ~ .. C O <br />Pnme Farmlands ,---^. <br />- G ~' radian Wnds <br />_ D:: 8 B O o iVUmbsr of Pormrned Acres-.- <br />- ~ ' <br />= .`_J _ •.' - ___ <br />''D r ~ Alluwel Valley Floors ' <br />+` ~ •._ - <br />H <br />_ <br />_-.: E.-~ 9 a ,._ Number of DisWrbed Acres , . , <br />__ .` - ~_ - - ._. _ - _ - ~ Other __ _ <br />_ _~ : _. <br />- - ~ - - 25. Pertormance Standards fCodest ". ` _ - - _ _ _ _ _ <br />_ <br />_~ lac]nsCOn¢ Indicate ComDllance Code. For aM stantlerd marked 2 or 3 DroriOe nanative io SuDDOrt this determination. ~ _ - -. - <br />- Standards Tfrat Lim(! the Ellects to the Pertnn Area - .' ' - . ~ . '- Standrar~ds~Tnat Asure Reclamation Oualily and Timeliness <br />'~~-A~ 'DlStonce Yrohlbnions r _• -- _- "-~-ip.t roDSOli Aandtinp_--'_-••,~_-~____ ___~__ _ <br />- <br />w <br />- ~ 8 P7Mirtg Wnnin Permit Boundsrbs~ ~ t-- - _ - - _ - N ; ~ <br />Back!iilmq antl Grad"rap <br />,- ~ j ~ ~ -• ~ -- <br />- <br />C © Signs antl Markers = : - - ~ ~ <br />~ <br />+ -_ ~0 ~ Following Reclamation Schedub ~ .. . <br />- <br />- <br /> <br />c <br />I - _ D Sediment Confml Msowros ". - ~~ <br />- :- = <br />- <br />~ <br />. <br />~ _ P - Rer elation R uiremenls" ~ . <br />eU eq <br />4 <br /> <br /> <br /> <br /> <br />_ <br />- __ <br />-r <br />_ _ _ <br />' - _ <br />. . <br />1 <br />I E~ n tl tll ton uireme <br />t <br />- pea sn Can cal n s <br />Re0 <br />_ -._ .. - <br />B <br />Satlinwnl Control <br />~ _ <br />. - - <br />, _ _ __ <br /> <br /> <br />_ _ <br /> <br />_ <br />. <br />_ <br />- _ <br />_ <br />Dis 1 t S il. <br />O. osa o Excess <br />D O. _ <br />ll tRAf . <br />Po .-- <br />wm <br />qq <br />._ . ~ -- <br />~ :- <br />' <br />_ <br />_ . _ .. <br />._ _ <br />- -_- - <br />- - - ~ - - - - ~ . <br />~ R ®Hantllinp o1 Acid or Toxic Materials.. J <br />~ . - ~ -- - -' <br />_ F ~ EMluant lJmlta - _ ~ _ _ .. _ <br />~ '- - - ~ - <br />_ <br />_ .. <br />G ~ Surtace Water MOnltoring ~, ~ <br />- ~ 5 ~ Hlghwall Elimination _ - . <br />_ <br />__ <br />.-. _ ~ - - - ~ <br />'. T' ®DownsloDe Spoll Disposal ~O I~~t <br />.. H Ground Water Monltorln <br />g <br />~~ ~56V~ ~~•- <br />® <br />~ <br />P <br />i <br />t Mi <br />tl U <br />' <br />L , <br />tAlyl ' <br /> <br />_ os <br />n <br />ng <br />an <br />se - - _ <br />_ <br />V ~ <br />Y <br />' <br />. ~ J ®_Bleating Proeedurea `~0~ OVl : ~ <br />ti <br />T <br />m <br />V <br />C <br />t <br />f O . <br /> <br />~ ion o <br />~ <br />essa <br />pera <br />ons: <br />e <br />porary <br />~ HauUACCeas Road Design antl Maintenancer <br />J _ . ~ _ <br />1 l <br />.' K ~ Rsluaa ImPOUndmsnta ~0~1 IS ~~ Wa~ l W ~ Other <br />- <br />~ <br /> <br />L- ~ Other:• Specify ~ - .. <br />- __ .. . - .. . ' - .. -' <br />' <br />_ <br />~, _. ..: <br />~ -~ .'-l DIa1rlDUilon: Original • Field Ollite. Green - Headquarters, Blue -Slate's CODY• Yellow -Inspector's Copy. Pink -File CORY. ~ ~ IE - 163 (t/B3) <br />