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iii iiiiiiiiiiiii iii <br />` r • ~ • ~ Pape t el 7 Papas <br />United States Department of the Interior ~~AR 2 0 °69 For Office Use Only <br />Office of.Surface Mining MINED <br />Mine Site Evaluation Inspection Repq~~C~MATION .Nets <br />L71y S 0 ,b ,p <br />i i <br /> Y Y M M B/icn Repon <br /> 10. Dale OI Inspection <br />2. Name of Permittee 9. MSHA Number ry y M M D D) <br /> / <br />I <br />tr <br />o <br />~ <br />or <br />- <br />- <br />J <br />~ 0~~ <br />3. Street Atldress erm <br />it N <br />umber <br />1 <br />1. <br />Sta <br />e P <br />l <br /> ~ <br />~~ <br />, <br />~ <br />~I <br />~~ <br />f~ <br />[ <br />G1~Gl~ <br />4. City 5. State t2. Name of Mine <br /> S ® ~ ~.~~- III ~- Tiiii <br />6. Zip Code 7. Area Cotle 8. Telephone Number <br />~' ~t 7 - <br />[~L=1"~J <br />O O 13. County Cotle td State Cooe 15. ~Irata <br />i <br />~ ~ 16. Slnte Area Oflice <br /> <br />r- I; I <br />Go Orzaeo yr <br />17. OSM Field 18. OSM Aree 19 OSM 20. Type of Irspe::lion 21. Joint Inspection 22 Inspector's ID <br />Olllce No. Office No. Sample No. <br />® ~ D O / (Code) `rYZe/s No <br />LJ-LlL. J ~ ~I No. <br />23. Stetu9 24. Type o+ Activity IC'teck applitpblp Coxes). <br />A O I Type of Permit <br />A ~ Steep Slope <br />E ~ Antnracite <br />B ® Mine Status (COdel <br />B ~ Mountain fop Removal <br />F ~ Federal Lands <br />C ~ Type of Facility ICotle) <br />~ <br />C ~ Pnme Farmlands <br />G ~ Intlian Lands <br />y~ ~ p~. <br />~{,~ ~ ~ /~ ~ <br />p CLNyLJ--~3LI Number of Permi7ted Acres <br />D ^ Alluvial Valley Floors <br />H ~ Other <br />E ~ • Number of Disturbed Acres <br />25. Performance S:antlartl5 ICotlesl <br />Inahuellena: Intlicete compliance Cotle. For any standard marketl 2 cr 3 provide narrative to support this tletrrmination. <br />Slantlards Thal Limit tha Elfects to the Permit Area Stantlartls Tnat Assure Reciam al:on Quality and Timeliness <br />A (n Distance Hrohibitions <br />i44 <br />~~ M <br />J ~ToDsoil Hantlling <br />u <br />~-- <br />Mining Wltnln Permit Bountlane5 <br />B - <br />i <br />N I, I Back!ilhnq ana Grzdmg <br />~ <br />--~ <br />C ~ Signs and Markers Following Reclamai!on $chenule <br />O <br />;~ <br />D ~ Sediment CAntrol Measures ~ Reveyetalion Requirements <br />P 4 <br />E ~ lksipn end Cenilicalion Requirements- - <br />O ~ Disposal of Excess Spoil <br />Sediment Control <br />R ~ Mantllinp of Acid or Toxic Materials <br />F ~ Effluent Limits <br /> <br />G ~ Surface Water Monitoring S ~ Highwall Elimination <br /> <br />H n Ground Water Monitoring T ® Downslope Spoil Disposal <br />Ic~-~ U n Post Mining Lantl Use <br />J <br />1 I' I Blasting Procedures <br />i;-i LL- <br />V a Cessation of Operations. Temporary <br />J n Haul/Access Road Design and Maintenance <br />44----ii <br />W ~ Olnei ___ <br />_ <br />N ~ Reluse Impoundments _ <br />L ~ Other: SDecify <br />Diatriouhon: Onpinal ~ Field Office, Green ~ Heatlouarters. Blue ~ State's Copy. Yellow ~ Inspen or's Copy Pink ~ Fne Copy IE ~ 16311IB31 <br />J <br />