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,~ T For The Following Entries, Circl e The Appropriate Choice: = nspec a an oun to comp Lance, NA = Inspection Topic n ot a pplicable, N =Not Inspected, R =Inspected and Commen ts noted, Y =Inspected and Viol atio ns (NOV) or Cessati on Order ( CO) issued, B =Inspected and both Comments noted & V iola tions or C essation Order issued, T = 10 Day Notice Issu ed by OSM Overs ight Per sonnel, S =Sample taken and s ent to the lab from analysis - describe type ana location of s ample taken under comment s ection. GENERAL INSPECTION TOPICS: CORDS........... L Y / NA / R / Y / B / T / S ] LCJ SIGNS AND MARKERS ................. L Y / NA / N R / V / B / T / S ] LCJ ROADS ............................. L Y / NA / N / R / V / B / T / S ] LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /~ V / B / T / S J LCJ BACKFILL & GRADING ................ L Y / NA R / V / B / T / S J LCJ EXPLOSIVES ........................ L Y ~ / NA / R / V / B / T / S j LCJ PROCESSING WASTES ................. L Y / NA N/ R / V / B / T / S J LCJ SUPPORT FACILITIES ................ L Y / NA ~/ R / V / B / T / S ] LCJ TOPSOIL ........................... L Y / NA /~ R / V / B / T / S ] LCJ GENERAL MINE PLAN COMPLIANCF_,,,,,, ~ NA / N / R / V / B / T / S ] LCJ FISH & WILDLIFE ................... L Y ~/ NA / R / V / B / T / S ] LCJ REVEGETATION ...................... L Y / NA N R / V / B / T / S ] LC1 AIR RESOURCE PROTECTION........... L Y / NA / R / V / B / T / S ] LCJ SLIDES & DAMAGE ................... L Y / NA N / R / V / B / T / 5 ] LCJ SUBSIDENCE ........................ L Y / N / N/ R / V / B / T / S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y / NA / N R / V / B / T / S J LC1 OFFSITE SUPPORT FACILITIES........ L Y / NA N R / V / B / T / S ] LCJ RECLAMATION SUCCESS ............... L Y / NA /~/ R / Y / B / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... L Y /® / N / R / V / B / T / S J (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y /~/ N/ R/ V/ B/ T] (2j -------------------- LSpaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.