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}} For The Following Entries, Circle The Appropriate Choice: ~ Y = Inspected and tound in compliance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, Y =Inspected and Violations (NOV) or Cessation Order (CO) 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 and location of sample taken under comment section. GENERAL INSPECTION TOPICS: GORDS........... L Y / NA / ~/ R / V / B / T / S J LCJ SIGNS AND MARKERS ................. l Y / NA / ®/ R / V / B / T / S J LCJ ROADS ............................. L Y / NA / (pl)/ R / V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / ®/ R / V / B / T / S lCJ BACKFILL & GRADING ................ L Y / ~ / N / R / V / B / T / S LCJ EXPLOSIVES ........................ L Y / IllA7 / N / R / V / B / T / S LCJ PROCESSING WASTES ................. L Y / l~A / N / R / V / B / T / S LCJ SUPPORT FACILITIES ................ L Y / NA / ®/ R / V / B / T / S LCJ TOPSOIL ........................... L Y / NA / ~/ R / V / B / T / S J LC] GENERAL MINE PLAN COMPLIANCE,,,,,, L®/ NA / N / R / V / B / T / S LCJ FISH & WILDLIFE ................... L Y / NA /®/ R / V / B / 7 / S J LCJ REVEGETATION ...................... L Y / NA ( ~/ R / V / B / T / S LCJ AIR RESOURCE PROTECTION........... L Y / NA / Q~/ R / V / B / T / S J LCJ SLIDES & DAMAGE ................... L Y / J~ / N / R / V / B / T / S J LCJ SUBSIDENCE ........................ L Y / NA /(~/ R / V / B / T / S LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y / NA /CN7/ R / V / 8 / T / S 1 LCJ OFFSITE SUPPORT FACILITIES........ L Y / ® / N / R / V / B / T / S LCJ RECLAMATION SUCCESS ............... L Y / NA / N~/ R I V / B / T / S J LCJ SPECIAL CATEGORIES OF MINING...... L Y /~ / N / R / V / B / T / S J (1) _ L20 - - - - - - - - - - - - - - - - - - - (2) Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y / NA / N / R / V / B / T ] I1) (2) - - - - - - - - - - - - - - - - - - - - (3) -------------------- - - - - - - - - - - - - - - - - - - - - L20 Spaces Max] NOTE: LCJ Required Entry.