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iii iiiiuiuim iii <br />999 <br />Pepe 1 pl 2 Papea <br />Ir~r~ri~ irli~ <br />United 'States'Department of the Interior <br />Offic <br />of S <br />f <br />Mi <br />i <br />UC ~ Q 19 For Office Use Only <br />92 <br />e <br />ur <br />ace <br />n <br />ng J <br /> <br />Mine Site Evaluation Inspectilin Report Mined Lan la lb to <br /> <br />m <br />m <br /> .Reclamation f7i islob~`M <br /> Re <br />2. Name o/ Permitle9 ~ ~ <br />' " <br />_ ~ .. <br />~9' MSHA Number ••" 10. Data of Inspection <br />(Y Y M M D D) <br /> e ~ ~ . ; 0 5 -, o S z on ~ ~ 9 obis, <br /> 3. Street Atltlress ~ ~ ~ .41. Slaty Permit Numbermber • - <br />- J z 5 N i k j. : =81- 011 I3I I ~~L <br />LJ <br />L <br />L i <br />' 4. City - ~ _ : 5. Stale _ <br />__ <br />_ <br />12.,Name of Mine ~~;~~. ~ <br />8. Zip Code ~ ~ . ! 7- Area Code.~'• "B. Tetlephone Number 13_Courity Code ~14. Slate. Cod ~la . t6. Stale Aroa Ollice <br />t2. OSM Field ~-18:,_OSM Area' := .•19.'OSM ~ - <br />Office No. Office No. -~ .Sample No. ~ ~ 20aFyge of Inspectu)n . '~ 21. Joint-InSpeclibn, <br />•~,-.(Code) ~ '~" [Y~~s 'nnb' 22 InsDector's ID <br />No. <br /> <br />23. Statua~ ~ ~ _ 24. Type o! Actibity-(c'reck applicable Eozesr. <br />A ® TYPe of Permit ~ <br />- ~ ~ • <br />' A . • ~ Sleep SIPPe ~ <br />E ~ .Anlhra[ite <br />B ~ ®' ' Mige~Stalus-(yodel - <br />' - <br />~ .- <br />~ B <br />.~~ Mountain'rop. ReniGval <br />~ <br />? <br /> <br />C Type of.Facility (Code) <br />® <br />~~ ' : <br />~ F ~ <br />rat Lands <br />etl <br />' <br />. <br />' C ~ Prime Farmlands G ~~ Indian Lands <br />D ~-F-~.~~~ Number o/ Permitlatl ACreS <br />~ <br />~ <br />D ~' Alluvial'Valley Floors ~,~ <br />H ~ Other <br />~ <br />E LSiJY--~[J7S2JJ7.J Number of Disturbed Acres . <br />25. Performa nce Standards (Coded <br />Inatruetbne: Indicate compliance code. For any stantlard marked 2 or 9 provide narralwe In support lh~s tleterminatmn. <br />Standa:ds Thal Llmll the Ellects to the Permit Area. Standards That Assu•e Redam afipr,.0uahty antl T~melineos <br />A 11 1 Distance Prohibitions ~ <br />~~--1 <br />F---'' M n'TOpsoil Handling <br />44 <br />~J <br />B <br />n <br />Mining Wlthln Permit Boundaries ~ N <br />n <br />Back!i; l~r~q'and Grading <br />L <br />~J <br />C ~ Signs and Markers ~ Following Reclamation Schedule <br />O <br />~ j <br />0 ~ Sediment Control Measures' P 4 Reveyetahon Requirements <br />E ~ Design and Cenlflcation Requirements- ~ O 4 Disposal of Excess Spoil <br />4~ <br />Seaimenl Control <br />n <br />Eltluent Llmlts <br />F R ~ Handling of Acid or To><~c Materials <br />LS-~ <br />vs-J ~ <br />n I~ <br />S I 1 I Hignwall Elimination <br />F <br />- <br />' <br />'- <br />Surface Water Monitoring <br />G <br />4-' <br />H ~ Ground Water Monitoring 1 <br />- <br />- <br />1 <br />T I 1 1 Downslope Spoil Disposal <br />'-i-~ <br /> U n Post Mining Land Use <br />I ~ Blasting Procetlurea '+' <br /> <br />_ J n Haul/ACCesa Road Design and Maintenance <br />~ V n Cessation of Operations Temporary <br />L~J <br />4- <br />K © Re/use Impoundments COaI not wa5~t¢d W ~ Other - <br />L ~ Other: SDatify <br />Distribution: Original -Field Olllce, Green - Heatlquarlers, Blue ~ Stele's Copy, Yellow "Inspector's Copy. Pink ~ File Copy IE ~ 169 (11801 <br />