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<br />Y `T~ III IIIIIIIIIIIII III iF. <br />IJ. S. DEPT. OF THE INTE~2&R~cp ~a ~~\~o _ <br />OFFICE OF SURFACE NIIIVING RECI.A(~4ATION AND ~O~R~~1'IENT C -..~,. 1` <br />Mine-Site Evaluation Ins e~t~ a ort \cF r^~J <br />~~SUtiFAGi / <br />P t~,d,p t~..r,,.... <br /> <br />I. Permittee/Person <br />9. Permit Number 10. Tvpe <br />a. Permit h. RA <br /> WE ~ufLS- l(rAA /vt. I L -751- O1 $ pP ~$ <br />2. Address I I. Inspection Date 12. Inspection Type 13. Joint Inspection <br /> F~• o ID D -ZS-46 SP ~ vn' <br /> <br />3. City 4. <br />State MAl OD I'1' <br />14. Permit Status <br />I5. Site Status <br />16. Facility Tvpe <br />AA . CO A~ AP ~~ <br />5 Zip Code 6. Phone Number 17. OSA1 Office p I8. RSI K 19. Land Code <br />I~4 -~ 303 75 2171 <br />7. Operator if Different than Permiuee 20. M.S.H.A. ID i! 21. State Code 22. Cuunp' Code <br /> Os-ossos og 1D3 <br />8. Mine Name 23. AVS Petmittee Entit }' ID Number 23b. State Office <br />VESERaDO a'V~ hNE os 835- <br />24. Performance Standard Categories <br />A. Administrative <br />I. _Islining within Valid Permit <br />2 ltlining within Bonded Area <br />3. _Terms 8 Conditions of Permit <br />4 Liabilit}' Insurance <br />S. Ownership and Control <br />6. _Temporary Cessation <br />B. Hydrologic Balance <br />L _Drainage Control <br />2. Inspections cC Certifications <br />3. Silta!ton Structures <br />4. _Discharge Structures <br />S. Diversions <br />6 -Effluent Limits <br />7. _Ground Water Monitoring <br />8. _Surface Water Monitoring <br />9. _Drainage -- Acid-Toxic Materials <br />I O. Impoundments <br />I I Stream Buffer Zones <br />C. Topsoil & Subsoil <br />(.--Removal <br />? -Substitute Materials <br />3 -Storage and Protection <br />4 Redistribwion <br />25.Inspection Frequency <br />a Dale of Lasi <br />Stale Compl <br />ete _ /~~ <br />~ <br />Inspection / 7 <br />Frequency Cor previou 4 Calendar Qtrs. <br />b Numner of Number of <br />requned compete (~ <br />compl?Ie ~ inspections ~ J <br />inspecions condugetl <br />c Number of Number al <br />recr~red partial <br />partial _ inspen~ons <br />msretlions conduned <br />D. Backfilling & Grading <br />(. -Exposed Openings <br />2. ~Contemporaneous Reclamation <br />3. _Approximate Original Contour <br />4. _Highwall Elimination <br />5. _Steep Slopes (includes downslope) <br />6. _Handling of Acid & Toxic Materials <br />7. _Stabilization (rills and gullies) <br />E. Excess Spoil Disposal <br />(. ,Placement <br />2. _Drainage Control <br />3. ,Surface Stabilization <br />4. `Inspections & Certifications <br />F. Coal Mine Waste <br />(Refuse Piles/Impoundments) <br />(._Drainage ConVOI <br />2. Surface Stabilization <br />3.~Placement <br />4._Inspections and Certifications <br />5._Impounding Structures <br />G. Use of Explosives <br />(.-Blaster Certification <br />2._Distance Prohibitions <br />3._Blast SurveylSchedule <br />4._Warnings d Records <br />5. Control of Adverse Effects <br />26. Inspection Hours <br />I ~. 0 a. Permit Review <br />S.~ b. Inspection Time <br />11~ ~ c. Travel Time <br />~r~ d Report Writing <br />H. Subsidence Control Plan <br />L Roads <br />I. Road Construction <br />2. Certification <br />3 _Drainage <br />4._Surfacing and Maintenance <br />5. Reclamation <br />J. Signs fi Markers <br />1._Signs <br />_t`tarkers <br />F:. -Distance Prohibitions <br />L. Re.'egetdtion <br />(.-Vegetative Cover <br />2._Timing <br />M. _Poslmining Land Usc <br />N. Other II r <br />_I)s eciai TOC43 ~NS~ <br />_2>~eR CerJ'~. ~a~la~r{iorJ _ <br />27. Bonded Acres <br />a. Total <br />bonded <br />b. Phase 1 <br />rclcased <br />c Phase 11 <br />rclcased <br />d. Phase III <br />rclcased <br />28. Acres <br />0~=Z1•-1~ a. Pcrmlucd <br />80 ti h Disturbed <br />(EstimatcJ) <br />1 aoe.. ~~ ~~, ,w <br />