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~` For The NA N R Y B T S Following Entries, Circle The Appropriate Choice: nspec a an oun in comp lance, Inspection Topic not applicable, Not Inspected, Inspected and Comments noted, Inspected and Violations (NOV) or Cessation Order (CO) issued, Inspected and both Comments noted & Violations or Cessation Order issued, 10 Day Notice Issued by OSM Oversight Personnel, 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 / I~A / N / R / V / B / T / S ] LCJ SIGNS AND MARKERS ................. L 1' / ® / N / R / Y / B / T / S ] LCJ ROADS ............................. L 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 / ®/ Y / B / T / S ] LCJ EXPLOSIVES ........................ L Y/ NA / N/ R/ V/ B/ T/ S J LCJ PROCESSING WASTES ................. L Y /(~ / N / R / V / B / T / S ] LCJ SUPPORT FACILITIES ................ L Y /~ / N / R / V / B / T / S ] LCJ TOPSOIL ........................... L Q' NA / N / R / V / B / T / S ] LCJ GENERAL MINE PLAN COMPLIANCE,.,,,, L Y / ® / N / R / V / B / T / S J LCJ FISH & WILDLIFE ................... L Q/ NA / N / R / V / B / T / S ] LCJ REVEGETATION ...................... l Y / NA / N / ®/ V / B / T / S ] LCJ AIR RESOURCE PROTECTION........... L®/ NA / N / R / Y / B / T / S J LCJ SLIDES & DAMAGE ................... l Y / ~h / N / R / V / B / T / S ] LCJ SUBSIDENCE ........................ L Y/ ®/ N / R / V / B / T / S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y /~ / N / R / V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y / N® / N / R / V / B / T / S J LCJ RECLAMATION SUCCESS ............... L Y / NA / N /®/ V / 8 / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... L Y / ~/ N / R / Y / B / T / S ] (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - Lr:J 07HERS ............................ L Y/ Q/ N/ R/ V/ B/ T J (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - NOTE: LC1 = Required Entry.