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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, Y =Inspected and Violations (NOV) or Cessation Order (C0) 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 ana location of sample taken under comment section, GENERAL INSPECTION TOPICS: CORDS........... L Y / NA / N /~ / V / B / T / S ] LCJ SIGNS AND MARKERS ................. LQ / NA / N / R / V / B / T / S J LCJ ROADS ............................. L Y / NA / N / ~/ V 1 B / T / S LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /~/ V / B / T / S J LCJ BACKFILL & GRADING ................ L Y / NA / N / Rv' / V / B / T / S J LCJ EXPLOSIVES ........................ L Q / NA / N / R / V / B / T / S LCJ PROCESSING WASTES ................. L Y / l~/ N / R/ V / B / T / S J LCJ SUPPORT FACILITIES ................ IQ / NA / N / R / V / B / T / S J LCJ TOPSOIL ........................... L Y / NA / N / ~/ V / B / T / S LCJ GENERAL MINE PLAN COMPLIANCE,,.... L Y / NA / N /(A~ / V / B / T / S LCJ FISH & WILDLIFE ................... L (",1 / NA / N / R / V / B / T / S ] LCJ REVEGETATION ...................... L Y / NA / N /vR / V / B / T / S ] LCJ AIR RESOURCE PROTECTION........... L Y / NA / N /~/ V / B / T / S LCJ SLIDES & DAMAGE ................... L Y / ® / N / R / V / B / T / S LCJ SUBSIDENCE ........................ L Y / I~ / N / R/ V / B / T 1 S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y / ~ / N / R / V / B / T / S ~ LCJ OFF5ITE SUPPORT FACILITIES........ L Y / NA/ / N / R / V / B / T / 5 J LCJ RECLAMATION SUCCESS ............... L Y / NA / N /~/ V / B / T / S LCJ AL CATEGORIES OF MINING...... SPEC I L Y / NA / N / ®' V / B / T / S J / ~ ~ -------- (2) `- - - - - --- - - S paces (3) ----------- - - - - - - - - - - - - - - - - - - - --- - - - - - - - MaxJ L~=J OTHERS ............................ L Y /~/ N / R/ V/ B / T ] (1) L20 (2) -------------------- Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCj = Required Entry.