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For The Following Entries, Circle The Appropriate Choice: ~ = nspec a an oun in comp lance, p NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, V =Inspected and Viol ations (NOV) or Cessation Order (CO) issued, B =Inspected and both Comments noted & Viol a tions or Cessation Order issued, T = 10 Day Notice Issu ed by OSM Oversight Personnel, S =Sample taken and s ent to the lab from analysis - describe type and location of sample taken under comment s ection. GENER AL INSPECTION TOPICS: CORDS........... L Y/NA/©/R / V / B / T / S ] LCJ SIGNS AND MARKERS ................. L Y / NA /~/ R / Y / B / T / S ] LCJ ROADS ............................. ~/ NA / N / R / V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N ~/ Y / 8 / T / S LCJ BACKFILL & GRADING ................ L Y /~/ N / R / V / B / T / S LCJ EXPLOSIVES ........................ L Y / NA ~/ R / V / B / T / S Lr,J PROCESSING WASTES ................. ~/ NA / N / R / V / B / T / S LCJ SUPPORT FACILITIES ................ L Y / NA / N /~ V / B / T / S J LCJ TOPSOIL ........................... ~/ NA / N / R / V / B / T / S J LC] GENERAL MINE PLAN COMPLIANCE,,,,,. ~/ NA / N / R / V / B / T / S J LCJ FISH & WILDLIFE ................... L Y / NA /~/ R / V / B / T / S J LCJ REVEGETATION ...................... L Y / NA / / R / V / B / T / S LCJ AIR RESOURCE PROTECTION........... L Y / NA ~/ R / V / B / T / S LCJ SLIDES & DAMAGE ................... l Y / NA / N / R / V / 6 / T / S J LCJ SUBSIDENCE ........................ L Y/ NA /~ R / V / B / T / S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. ~/ NA / N / R / V / B / T / S LCJ OFFSITE SUPPORT FACILITIES........ L Y / NA / N / R / V / B / T / S J LCJ RECLAMATION SUCCESS ............... L Y NA / N / R / V / B / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... L Y NA / N / R / V / B / T / S (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y NA / N/ R/ V/ B/ T J (1) L20 (2) -------------------- Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ Required Entry.