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,.` _. <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Gepartmenl of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: 1303)832-8106 <br />Date <br />AVS Annual Review <br />Inspection Worksheet <br />Mine NamelPermit Ntunber O 7- 3'/ " l~ <br />Inspector Signature <br />Based on your ON-SITE Observation, please answer the following: <br />1) Mine ID sign <br /> <br />a) <br />Permittee / <br />Ilue //COLU7~1Y1 ~h~~ <br />b) Operator .a~YiC /%JD4:, 7~ ~ ~r <br />c) MSHA ID (not required to be on sign) <br />2) Direct inquiry (of persons on the site) <br />a) Permittee Q~4.e /florz2l~!~l ~ .aep~ <br /> <br />b) <br />Operator c <br />b~r~e /%luuh 1n <br />~ ervj <br />c) MSHA ID !'7 .S - O S ~ ~S <br />DIVISION O F <br />MINERALS <br />'GEOLOGY <br />AEC L'A'M ATION <br />MI NING•SA FETY <br />Bll Owens <br />Governor <br />Greg E. watcher <br />Executive Director <br />~M~chael B. long <br />Division Director <br />3) Is ownership/control information for permittee and operator noted in field consistent with <br />what is listed in the permit application? Yes ~ No <br />If No, what is in conflict? <br />DMG is required to verify this information as specified in the AVS MOU if the permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions). Annually as long as coal <br />extraction from the site has not been completed, DMG must determine whether officer/controller <br />information is complete and accurate in AVS. In making the determination of complete and accurate <br />information, on-site observations and direct inquiry of persons on the site is necessary. The information <br />on this form will be verified with AML, MSHA, and EIA information in AVS. Please return the form to <br />Johanna Cramer to be verified in the AVS. <br />