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For The Foll~~,ing Entries, Circle The Appropriate Choice: = nspec a an oun rn comp lance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, Y =Inspected ano Violations (NOV) or Cessation Order (CO) issued, B = Inspected and bath Comments noted 8 Violations or Cessation Ur der 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........... ~ NA / N / R / V / B / T / $ ] LC] SIGNS AND MARKERS ................. NA / N / R / Y / B / T / S 1 LCJ ROADS ............................. L Y / NA / N / ®/ V / B / T / S 1 LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /~/ V / B / T / S ] LC1 BACK FILL 8 GRADING ................ L~ NA / N / R / Y / B / T / S ] lC] EXPLOSIVES ........................ L Y /~/ N / R/ V / 8 / T / S J LCJ PROCESSING WASTES ................. L Y / NA / N /~/ V / B / T / S ] LC] SUPPORT FACILITIES ................ L Y / NA / N /~/ V / B / T / S ] LC1 TOPSOIL ........................... L Y / NA / N / V / B / T / S J LC] GENERAL MINE PLAN COMPLIANCE...... L Y / NA / N R V / B / T / S J ~-~ am, LCJ FISH 8 WILDLIFE ................... , L NA / N / R / V / B / T / S ] lC1 REVEGETATION ...................... L Y / NA / N ~ V / B / T / S J LC1 AIR RESOURCE PROTECTION........... L~ NA / N / R / V / B / T / S ] LC1 SLIDES 8 DAMAGE ................... L Y / NA / N / R / Y / B / 7 / S ] LC1 SUBSIDENCE ........................ l~/ NA / N / R / V / B / T / S ] LG] EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y / NA / N / ~/ V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y / NA / N ~/ V / B / T / S ] LCJ RECLAMATION SUCCESS ............... L Y / / N /~ V / B / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... L Y / ~ NA / N / R / V / B / T / S 1 (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y / NA / N / R / V / B / T ] (1) l20 (2) -------------------= SDaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.