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i. For The Following Entries, Circle The Approprieta Choice: = nspuc a an oun in Comp lance, NA = Inspection 7o pie not applicab]e, N Nit Inspected, R Inspected and Comments noted, Y =Inspected and Violations (NOV) or Cessation Oroer (CO) issues, B = Inspected and both Comments noted 8 Violations or Cessation Order issued, T = 10 Day Notice Issues 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........... L Y / NA / N /® / V / B / T / S ] LCJ SIGNS AND MARKERS ................. L~Y'/ NA / N / R / V / 8 / T / S ] LCJ ROADS ............................. L ©/ NA / N / R / V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /® / V / B / T / S J LCJ BACKFILL 8 GRADING ................ L Q/ NA / N / R / V / B / T / S J LCJ EXPLOSIVES ........................ L Y / ®/ N / R / V / B / T / S ] L~=J PROCESSING WASTES ................. L Y / ~/ N / R / V / B / 7 / S LCJ SUPPORT FACILITIES ................ L Y/ ®/ N / R / V / B / T / S J LCJ TOPSOIL ........................... LG / NA / N / R / V / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCE...... l© / NA / N / R / V / B / T / S ] LCJ FISH 8 WILDLIFE ................... L ~/ NA / N / R / V / B / T / S ] LCJ REYEGETATION ...................... L Y / NA / N / ® / V / B / T / S J LCJ AIR RESOURCE PROTECTION........... L(~j / NA / N / R / V / B / T / S ] LCJ SLIDES 8 DAMAGE ................... L i~/ NA / N / R / V / 8 / T / S ] LCJ SUBSIDENCE ........................ L Y /~ / N / R / V / B / T / S J LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L©/ NA / N / R / V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y / 1~ / N / R / V / B / T / S J LCJ RECLAMATION SUCCESS ............... L d / NA / N / R / V / B / T / S ] lCJ SPECIAL CATEGORIES OF MINING...... L Y / ® / N / R / V / B / T / S ] (1 ) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ NA / N/®/ V/ B/ T J (1) ~~ ~-~~---------------= Leo (2) -------- Spaces (3) ------------ Max) - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.