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w <br />rape 1 of 1 Pages <br /> United States Department of the Interior <br /> Office of Surface Mining <br /> Mine Site Evaluation Inspection Report <br />28. State Pertnll Number 27. Date of Inspection <br /> YMMDD <br />C o~ 'r ¢ °, sic ~ - a <br /> <br />28. Yee No Do mining and reclamation actlvillea on the site comply with the plans In the permlt7 <br /> ^ 1} no, rovlde narrative to eu ort this determinatlan. <br />29. Indlcete number of complete and partial Inspections conducted by the State to date for this annual review period: <br />. J' <br />29a. p - Number of Completes ~ 29b. m Number of Partials , <br />30. Indlcete number of complete and partial Inspectlona required by the State during this-annual review period: <br />30a. C - Number of Completes 30b. ~ Number of Partials <br />31. Hae Inapectlon frequency been mel7 <br /> Yes No Yes No <br />31 a. ~ ^ Completes 31 b. ~ ©Pertiels <br />32 FEDERAL ENFORCEMENT INFORMATION. [Enter violation number. Check epproDrlate box[es)) <br />Ten-Day Notice No. Notice of Violation No. Caseation Order No. Violation Codes <br />A ... ^ ...... ............... ^ .,,.......,,.....,,..... Authorizations to Operate <br />B ^ ..................... ^ ...... ............... ^ ........................ Signs and Markers <br />C ^ ..................... ^ ....,. ............... ^ <br />........................ Backfilling and Grading <br />D ^ ..................... ^ ...... ............... ^ ........................ Hlghwall Ellminetlon <br />E ^ ^ ^ Rills and Gullies <br />F ^ ..................... ^ ^ Improper Fills <br />G ^ ..................... ^ ^ Topsoil Handling <br />H ^ ..................... ^ ...... ............... ^ ........................ Sediment Ponds <br />I ^ ^ ^ Effluent Limits <br />~ ^ ..................... ^ ...... ............... ^ ........................ Water Monitoring <br />K ^ ^ ^ ........................ Buffer Zones <br />L ^ ..................... ^ ...... ............... ^ ........................ Roads <br />M ^ ..................... ^ ...... ............... ^ ........................ Dams <br />N ^ ..................... ^ ...... ............... ^ ........................ Blasting <br />O ^ ^ ^ Revagetetlon <br />P ^ ^ ^ Spoil on the Downslope <br />O ^ ..................... ^ <br />...... ^ <br />............... ........................ Mining Without Permit <br />R ^ ^ ^ Exceeding Permit Limits <br />S ^ ^ ^ Distance Prohibitions <br />T ^ ^ ^ Toxic Meterlels <br />~ ^ ..................... ^ <br />...... <br />............... <br />^ ........................ Other Violations <br />33. Name of Authorized Rapresentetlve (print or type) <br /> r: .: ~' (z ~ . i. <br />, <br />Signature of Authorized Representative - Date ~ <br />" d <br /> ,;,-. ~. , r.. _ ~ ~ - ~_ ~l ~ ~ v s o <br />Slgnatwe of Re~wlri® Ofildal /..i <br />-~ Date <br />, ~: ~ <br /> <br />-j_ J . <br />-- <br /> <br />Distribution: Original • Ffsld Office, Grsen - Haadpuarters, Blue -State's Copy, Ysllow - Inspector's Copy, Plnk - Flle Copy IE - 1B3 (tlB3) <br />