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~~e ~~~41i~ III IIIIIIIII IIII III Prrgatol2 Pagee <br /> 999 <br />United States Department of the Interio~EP 6 jQG.~ For Office Use Only <br />Office of Surface Mining <br /> <br />Mine Site Evaluation Inspection AA gor~INED ~qNp <br />R~~%LAMATIpIV OIV ,a <br /> <br />~ ,b ,p <br /> <br />~ m <br /> I0 <br /> Y Y M M Batch Report <br /> <br />2. Name of Permittee <br />g MSHA Number 10. Date of lnspect~on <br />(V V M M D D) <br /> ~ <br />I <br />1. <br />I <br />I. <br />; <br />.l _ <br />- <br />' [ <br /> 3. Slreel Address ~ 11. Stale <br />Permit Numbe <br /> r ~ <br />~ (~T~~'~' <br /> 4. City 5. Stale ti. Na <br />m <br />e <br />f <br />M <br />in <br />o <br />e <br /> <br />__ <br />~ ~ <br />~ <br />~ <br />~ <br />'~ <br />'_ <br />7~~ <br />~~,~ <br />/'f. I I~' I I ~I~LL1 <br />~ <br />6. Zip Gode 7. Area Cotle 8. Telephone Number 13. Counq~ Code'rrta. Slajj~te Code i~15mI~SIr Ilala 16. Slave Aiea Ollice <br /> <br />17. OSM Field 1B. OSM Area 19. OSM 20. Type of lrsPe^_hon 2t. Joint Inspection 22. Inspector's ID <br />Office No. Ollice No. Sample No. (Code) Yes No No. <br />23. Status 24. Type el A[Iinly (c.'+eck applicgCle coxes). <br />A '~/ Type of Permit <br />A LLL!! Steep Slope <br />E ^ Anlhrarile <br />B ~ Mine Status (Cotle) <br />B ~~ Mouutam Top Removal <br />F ~~~ Fedel al Lands <br />C ~ Type of Facility (Code) <br />C ~ Prime Farm!and5 i -- <br />G ~~ Indian Lands <br />D ~ Number of Permitletl Ar.res <br />D ~ Allunal Valley Floors <br />H ~ Other <br />E ~~, Number of Disturbetl Acres <br />25. Performance Standards (Codes? <br />In~trucllona: Intlicate acm Dliance cotle. Far any stantlard marked 2 or 3 provide narrative In su DPOrt this deierminati~n. <br />Standards Thal Llmil the Ellects to the Permit Area Standards Thdl Assu•e Reclamalior. Ou.ality antl Timeliness <br />A ~ Distance Prohibitions M l~ Topsoil Handling <br />~ <br />B ~ Mining Within Permit Boundaries N <br />~ Back!iil~rig and Grading <br />C ~ Slpns and Markers O ~ Following Reclart~ation Schedule <br />D ~ Sediment Control Measures P ~ Reveyetation Requirements <br />E ~ Desipn and Cert lllcalion Requirements- O ~/ Disposal of Excess Spoil <br />Sediment Control <br />R ~ Handling of Acid or Tozic Materials <br />F ~ Ellluant Limits <br />S ^1 Highwall Elimination <br />G ~ Surface Water Monilorinp <br />T ~ Downslope Spoil Disposal <br />H ~ Ground Water Mondoring <br /> <br />I ~ Blasting Procetlures U © Post Mining Lantl Use <br /> <br />J ~ Haul/Access Road Dasipn and Maintenance V ~ Cessation of Operations: Temporary <br /> <br />KRefuse Impoundments-r_n.~~t i- ~~ W ~ Other _ <br />L ~ Other: Specify "'~ ~~- ~-~ _ <br />Distribution: Original ~ Field Oll ice, Green <br />Headquart s. Blue -Slate's Copy, Yellow <br />Inspector's Copy. Pink ~ File Copy IE ~ 763 11/83) <br />