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4~ <br />_. <br />Pape ] of i Papos <br />• .I,~r <br />?'~ ed States Department of the Into <br /> Office of Surface Mining <br /> Mi ne Site Evaluation Inspection Report <br />28. State Permit Number 27. Date of Inspectltin <br /> Y <br />MM DD <br /> , <br />28. Yea No Do mining end reclamation activities on the site comply with the plane In the permlt4 <br />^ 11 no, rovlde narrative to su ort this determination. <br />29. Indicate number of complete and partlal Inspections conducted by the State to date for this annual revlew period: <br />29a. /~ ~ Number of Completes 29b.~ Number of Partials <br />30. Indicate number of complete and partlal Inspections required by the State during this annual revlew period: <br />30a ~ Number of Completes 30b. ~ Number of Partials <br />31. Has Inspection frequency been mall <br />Yea No Yes No <br />31a. ^ ^ Completes 31 b. ^ ~ Partials <br />32. FEDERAL ENFORCEMENT INFORMATION. [Enter violation number. Check appropriate box(es)[ <br />Ten-Day Notice No. Notice of Violation No. Cessation Order No. Violation Codes <br />A ^ ^ ^ Authorizations tc Operate <br />B ^ ..................... ^ ^ Signs and Markers <br />C ^ ....-...•...•..••...• ^ ,•. .....•...•-....... ^ <br />........................ Backtllling end Grading <br />D ^ ..................... ^ ... .................. ^ ........................ Hlghwell Ellminatlon <br />E ^ ^ ^ Rills and Gulllea <br />F ^ ^ ^ Improper Fills <br />G ^ ...••....•.......:-.. ^ ^ Topsoil Handllnp <br />H ^ • ...............••..• ^ ^ Sediment Ponds <br />I ^ ..................... ^ ... .................. ^ ........................ Effluent Limits <br />J ^ ............•..•••••• ^ ^ Water Monitoring <br />K ^ ^ ^ Buffer Zones <br />L ^ ..................... ^ ... .................. ^ ........................ Roads <br />M ^ ..................... ^ ... .................. ^ ........................ Dams <br />N ^ ..................... ^ ^ Blasting <br /> <br />P^ ^ ^ .,••.,,....••,,....•••,, Spoil on theDOwnelOpe <br />O ^ ^ ^ Mining Without Permit <br />R ^ ^ ^ Exceeding Permit Limits <br />S ^ ^ ^ Distance Prohibitions <br />T ^ ^ ^ Toxic Materials <br />~ ^ ..................... <br />... <br />^ ^ ........................ <br />.................. Other Violations <br />33. Name of Authorized Rep[@se nlative (print or type)-. <br />- .1 ~ - '~ i ` ~ ~ <br /> <br />Signaturq of Authorized Representatlve <br />Date <br />~~~ ~ <br />~• <br /> <br />Signature oCReviawing Official Date ~ "~ <br />~r~ , <br />{! " i <br />\ <br /> ~ <br />Distribution: Orlplnal - Fieltl Oftlce, Green - Heaoquanare, Blue • Stata'9 Copy, Yellow • Inspector's Copy, Pink - Flb Copy IE - 763 (t;a3) <br />