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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />IJIJ Sherman St., Room 215 AVS Annual ROVieW <br />Denver, ColoraAo 8020) <br />Phone:170J1866~J567 Inspection Worksheet <br />FA%:13071872-8106 _ <br />Date IL ~~ ~lJ <br />Mine Name/Permit Number I ~ ~ -~- S~) <br />Inspector signature <br />Rased on your on-site observation, please anaxer the <br />1) Mine ID sign <br />a) Permittee <br />b) Operator <br />c) MSHA ID <br /> <br /> <br /> <br /> ~ """ " ~-' <br /> ~~- <br />2) Direct inquiry (of persona on the site) <br />a) Permittee ~(,~'y'~~~`{~ C~,,( L(1 <br />b) Operator )(,li'YY~,~ <br />c) MSHA ID ~ - ~~~~{ <br />~~ <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Gov<mor <br />lames 5. Lochhcad <br />f o lloxidtJ :"i"e D"e"°' <br />Michael B. Long <br />Dnnion Dueclo~ <br />3) Is oxnership/control information for permittee and operator <br />noted in field consistent xith xhat is listed in the permit <br />application? Yes ~ No <br />If No, what is in conflict? <br />DMG is required to verify this information as specified in the AVS <br />MOU if the permitting action was approved subsequently to the MOU <br />(renewal, transfers and revisions). Annually as long as coal <br />extraction from the site has not been completed, DMG must determine <br />whether officer/controller information is complete and accurate in <br />AVS. In making the determination of complete and accurate <br />information, on-site observations and direct inquiry of persons on <br />the site is necessary. The information on this form will be <br />verified with AML, MSHA, and EIA information in AVS. Please return <br />the form to Erica Crosby to be verified in the AVS. <br />c:\avs\annual <br />