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<br />`~ ~ • • <br />fhe Follo~win~Entr~ies Circle, The Approrpiate Choice: <br />~= Tnspec -ted-and-fou- nd-i pomp fi ante, <br />NA = Inspection Topic not~a plicable, <br />N =Not Inspected,':: <br />R =Inspected and Comments noted, <br />V = Inspected and Violations (NOV) or Cessation Order (CO) issue <br />B =Inspected and both Comments noted !4 Violations or Cessation <br />Order issued, <br />T = 10 Day Notice Issued by OSM Oversight Personnel, <br />S =Sample taken and sent Go••the lab'from analysis -describe <br />type and location of sample taken under comment section. <br />GENERAL INSPECTION TOPICS: <br />C_ AVA LABIL Y 0 CORDS........... [ Y NA / N / R / V / B / T / S ] <br />[C] SIGNS AND MARKERS.......J.......... [~ / NA I N / R / V / B / T / S ] <br />~l.] ROADS ............................. [ Y / NA / N /~ V / B / T / S ] <br />[~] HYDROLOGIC BALANCE................ [ Y / NA /~/' R / V / B / T / S ] <br />[l.] BACKFILL & GRADING ................ [ Y / NA / N /~R / V / B / T / S ] <br />[(:] EXPLOSIVES ........................ [ Y / NA / N % R / V / B / T / S ] <br />[C] PROCESSING WASTES ................. [ Y / NA / N / R / V / B / T / S ] <br /> <br />[C] SUPPORT FACILITIES ................ [ Y / NA ~ / R / V / B / T / S ] <br /> <br />(C] TOPSOIL ........................... [ Y / NA / N ~ / V / B / T / S ] <br /> <br />[C] GENERAL MINE PLAN COMPLIANCE...... (~ / NA / N / R ~ ~ / B / T / S ] <br /> <br />[CJ FISH b WILDLIFE ................... [ Y / NA / Q / ~ / V / B / T / S ] <br />[C] REVEGETATION ...................... [ Y / NA / N /® / V / B / T / S ] <br />(C] AIR RESOURCE PROTECTION........... (Y / NA / N /~ / V / E ! T / S ] <br />[C] SLIDES & DAMAGE ................... [ Y / NA / N / R / V / B / T / S ] <br />[C] SUBSIDENCE ........................ [ Y / A / N / R / V / B / T / S ] <br />[C] EXCESS SPOIL & DEVELOPMENT WASTE.. [ Y / ~ / N j R / V / B / T / S ] <br />[C] OFFSITE SUPPORT FACILITIES........ [ Y / MA / N / R / V / B / T / S ] <br /> <br />[C] RECLAMATION SUCCESS ............... [ Y / NA / N / ~ / V / B / T / S ] <br />[C] SPECIAL CATEGORIES OF MINING...... [ Y / NA / N / R / V / B / T / S ] <br />(1) -------------------- [20 <br />(2) ____________________ Spaces <br />(3) -------------------- Max] <br />[C] OTHERS ............................ [ Y / NA / N / R / V / B / T ] <br />(1) - - - - - - - - - - - - - - - - - - - - <br />(2) - - - - - - - - - - - - - - - - - - - - <br />(3) - - - - - - - - - - - - - - - - - - - - <br />NOTE: [C] = Required Entry. <br />[20 <br />Spaces <br />Max] <br />.....~a_,v w _.~.a. ~ . eard.cr' r1 . .ra ..e l.. ~ ._. w ..ea-. - ~ <br />