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For the Follo.,ing Entries, Circle The Appropriate Choice: = nspec e an oun 7n comp lance, NA = Inspection Topic not applicable, N = Nit Inspected, R Inspected and Comments noted, V =Inspected and Violations (,yOV) or Cessation Ortler (CO) issuetl, B = Inspected and bath 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 ono location of sample taken under comment section. GENERAL INSPECTION TOPICS: CORDS........... L Y / NA / ~ R / V / B / T / S LCJ SIGNS AND MARKERS ................. L (~ / NA / N / R / V / B / T / S J LCJ ROADS ............................. L Y / NA / N / ~/ V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /~/ V / B / T / S J LCJ BACKFILL & GRADING ................ L Y / NA / N / ®/ V / 6 / T / S ) ICJ EXPLOSIVES ........................ L Y /~ / N/ R/ V / B / T / S J LCJ PROCESSING WASTES ................. L ©/ NA / N / R / V / B / T / S LCJ SUPPORT FACILITIES ................ L Y / NA / N /~/ Y / B / T / S J 1~J TOPSOIL ........................... L Y / NA / N/®/ V / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCE...... L Y / NA / N /®/ V / B / T / S LCJ FISH & WILDLIFE ................... L~/ NA / N / R / V / B / T / S J LCJ REVEGETATION ...................... LD/ NA / N / R / V / B / T / S LCJ AIR RESOURCE PROTECTION........... L Y / NA / ®/ R / V / B / T / S J LC] SLIDES 8 DAMAGE ................... L Y / NA / ©/ R / Y / B / T / S ] LCJ SUBSIDENCE ........................ o Y / NA / ®/ R / V / B / T / S J ~ LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L NA / / R / V / B / T / S LCJ OFFSITE SUPPORT FACILITIES........ L Y / NA / N / ®/ V / B / T / S LCJ RECLAMATION SUCCESS ............... L Y / NA /~/ R / V / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... L Y / NA / / R / V / B / T / S J (1) _ 120 - - - - - - - - - - - - - - - - - - - (2) Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ NA / N/ R/ V/ B/ T J (1) l20 (2) -------------------= Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - N07E: LCJ = Required Entry.