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For The Foll~~,ing Entries, Circle The APPropriate Choice: = nspec a an oun in comp lance, NA = Inspection Topic not applicable, N = Nit Inspected, R = Inspected and Comments noted, Y = Inspected and Violations (NOV) or Cessation Ortler (CO) issuetl, B = Inspected and both Comments noted 8 Violations or Cessation Ur der issued, T = 10 Day Notice Issues 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 / N /~/ V / B / T / S ] LCJ SIGNS AND MARKERS ................. L Y / NA / N / R / V / B / T / S J LCJ ROADS ............................. Y / NA / N / R / V / B / T / S ] LCJ HYDROLOGIC BALANCE ................ L Y / NA / N / ~ V / B / T / S J LCJ BACKFILL 8 GRADING ................ LlJ NA / N / R / V / B / T / S J LCJ EXPLOSIVES ........................ L Y /~ / N / R / V / B / T / S J Li:J PROCESSING WASTES ................. L Y / NA / N / R / V / B / T / S J LCJ SUPPORT FACILITIES ................ L Y / A / N / R / V / 8 / T / S ] LCJ TOPSOIL ........................... Y / NA / N / R / V / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCE,,,.,, Y / NA / N / R / V / B / T / S ] LCJ FISH 8 WILDLIFE ................... l Y NA / N / R / V / B / T / S J LCJ REVEGETATION ...................... L Y / NA / N / R / V / B / T / S ] LCJ AIR RESOURCE PROTECTION........... L Y / NA / N / R / V / B / T / S ] LCJ SLIDES 8 DAMAGE ................... l~/ NA / N / R / V / B / T / S ] LCl SUBSIDENCE ........................ L Y/ NA / N / R / V / B / T / S J LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y / NA / N / R / V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y / NA / N / R / V / B / T / S ] LCJ RECLAMATION SUCCESS ............... LQY / NA / N / R / V / B / T / S J LCJ SPECIAL CATEGORIES OF MINING...... L Y / NA / N / R / V / B / T / S J (p) Spaces (3) ---------- - - - - - - - - ---- - - - - - - - - - - - - - - - - MaxJ - - LCJ OTHERS ............................ L Y / NA / N ~/ V / B / T ] I1) - _ L20 (2) - - - - - - - - - - - - - - - - - - -------- Spaces (3) ------------ MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ Required Entry.