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For The Following Entries, Circle The Appropriate Choice: = nspec a an oun in comp lance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, V = Inspecteo and Violations (NOV) or Cessation Order (CO) issued, B =Inspected and both Comments noted & Violations or Cessation Order issued, T = 10 Day Notice Issued 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 / t(~/ R / V / B / T / S LCJ SIGNS AND MARKERS ................. L Q/ NA / N / R / V / B / T / S ] lCJ ROADS ............................. L Y / NA / N /~/ V / B / T / S LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /®/ V / B / T / S J LCJ BACKFILL & GRADING ................ L Y / Pf / N / R / V / B / T / S J LCJ EXPLOSIVES ........................ L Y / ®/ N / R / V / B / T / S J LCJ PROCESSING WASTES ................. L Y / ® / N / R / V / B / T / S J LCJ SUPPORT FACILITIES ................ L Y / N® / N / R / V / B / T / S LC] TOPSOIL ........................... L Y / N® / N / R / V / B / T / S LCJ GENERAL MINE PLAN COMPLIANCF_...... L~Y / NA / N / R / V / B / T / S ] LCJ FISH & WILDLIFE ................... L ©/ NA / N / R / V / B / T / S J LCJ REVEGETATION ...................... L Y / ®/ N / R / V / B / T / S LCJ AIR RESOURCE PROTECTION........... L~ / NA / N / R / V / B / T / S J LCJ SLIDES & DAMAGE ................... L Y /~ / N / R / V / B / T / S LCJ SUBSIDENCE ........................ L Y / N / 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® / N / R / V / B / T / S J LCJ RECLAMATION SUCCESS ............... L Y / N® / N / R / V / B / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... L Y / N® / N / R / V / B / T / S J (1) L20 (2) -------------------- Spaces (3) -------------------- Max] LCJ OTHERS . L Y/ N A/ N/~/ V/ B/ T J (1) Ab.i41L' -~S2L1~J~-~1J3 S U f ~S L20 (2) Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.