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For The Following Entries, Circle The Appropriate Choice: = nspec a an oun in comp lance, NA = Inspection Topic n ot applicable, N =Not Inspected, R =Inspected and Comments noted, V =Inspected and Viol ations (NOV) o r Cessati on Order (CO) issued, B =Inspected and both Comments noted & Viol a tions or Cessation Order issued, T 10 Day Notice Issu ed by OSM Over s ight Per sonnel, S =Sample taken and s ent to the lab from analysis - describe type and location of sample take n under comment section. GENERAL INSPECTION TOPICS: CORDS........... L Y/ NA / N /~ Y / B / T / S LCJ SIGNS AND MARKERS ................. L Y / NA / N ~ V / B / T / S LCJ ROADS ............................. ~ NA / N / R / V / B / T / S LCJ HYDROLOGIC BALANCE ................ L Y / NA / N ~7 V / B / T / S ] LCJ BACKFILL & GRADING ................ L Y /~i' N / R/ V / B / T / S J LCJ EXPLOSIVES ........................ L Y/ lGA / N / R/ V / B / T / S J LCJ PROCESSING WASTES ................. L Y /~ N / R/ V / B / T / S LCJ SUPPORT FACILITIES ................ ~ NA / N / R / V / B / T / S J LCJ TOPSOIL ........................... ~/ NA / N / R'/ V / B / T / S J LC] GENERAL MINE PLAN COMPLIANCF_,,,,,, ~/ NA / N / R / V / B / T / S LC1 FISH & WILDLIFE ................... L Y / NA / N ~ V / B / T / S J LCJ REVEGETATION ...................... L Y NA / N / R/ V / B / T / S J LCJ AIR RESOURCE PROTECTION........... La NA / N / R / V / B / T / S LCJ SLIDES & DAMAGE ................... ~ NA / N / R / V / B / T / S LCJ SUBSIDENCE ........................ L Y /~ N / R/ V / B / T / S LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y , N / N / R / V / B / T / S J LCJ OFFSITE SUPPORT FACILITIES........ L Y /(~/ N / R/ V / B / T / S 7 LCJ RECLAMATION SUCCESS ............... L Y 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) -------------------- Ma x7 - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y NA N/ R/ V/ B/ T J (1 ) (2) - - - - - - - - - - - - - - - - - - - - (3) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - NOTE: LCJ Required Entry. i~a3/9a L20 SDaces Maxj /~13/Z.