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~, <br />n <br />Papa 1 0l 2 Pages <br />e <br />United States Department oE' 1~;:.-- For Office Use Only <br />Office of Surface Mining . <br />992 <br />~ <br />1 <br />Mirtie Site Evaluation InsRection Re ,a ,b .p <br />m <br /> <br />pNIStUId~r <br />C• ~ <br />, m <br />ILJI-ll <br /> (1 <br />ERAI-S ~ "t~` Y V M M 9atcn ReOad <br />2. Neme of Permittee ~ - - '- <br />~' ..~ <br />,9, ~M$HA Number 70. Dale of Inspection <br />(V Y M M D D) <br /> <br />1 ~h <br />^ <br />, <br /> n ~~ ,t V ; ~ ~~ . <br />i <br /> ~ ~ <br /> 3. Street Address ' tt. Slate Permit <br /> 1 <br /> <br />J 1 Ct r n ~ <br />~ I <br />I <br />4. City <br />5. Stele 12. Na~me'01Q1i~12t1e. <br />6. ZID Coda 7. Area Coda ~ S. Telephone NuinDef "' 15. County Code 11. S+- "(~rt1e II75TIStr'a1 ta j16. SIa1e Arca Office <br /> ~ <br />17. OSM FIeW 18. OSM Area 19. OSM 20. Type of IrisDectior.: <br />~ <br />~tylgiM Inspection, 22 Inspector's ID <br />Olllc`e No. O~fllce No. Sampl~. , <br />(Code) ~ -Nb ~ No. , O <br />23. Status ~ 24. Type of Activity.~Gyt~gkeppficable poxesb <br />A ® TYDe of Permit ~ '~'?; <br />~ <br /> <br />8 ® Mine Status (Code) A <br />~ Steep Slope'.... - E ~ Anthracite <br /> <br />C ~ Type of Faclllly (Code) B ~ Mou!~tyn7op flertioval <br />~ F f ~ Federal Lands <br />L <br />f~~1~fn 7~t~~~TTT~1 C ^ Prime f~ermlands G ~ Indian Lantls <br />D l Number of Permllted Acres <br /> <br />E <br />N <br />b <br />f <br />ly <br />U <br />D ~ Alluvial Valley Floors <br />H Other <br />er o <br />ka-JQ~)-~la I -D-I <br />um <br />turbe <br />D <br />Acres ~ .- <br />25. Performance $Iandards (Codes! ' <br />Matructlpns: Intllcete compliance cotle. For any standard marketl 2 0! 5 provide narrative to supper( Ihls determination. <br />Standards That Linfil the Effects to the Permit Area ~ Slandartl5 TDaI Assfpe ABalamatior, Oualily antl Timeliness <br />A ~ Dlelance Hrohibilions M ~ Topsoil Handling <br />`` <br />B ~ Mining Wlthln Permit Boundarie9L1~r7 F~, III. <br />"'''' Back!ihmg and Grading <br />N <br />~ <br />C ~ Slpns and Markers VVVVVV r <br />-~ <br />O ,~ r I Following Reclarmt?on Schedule <br />~ <br />~r <br />D) ~ Sediment Control Measures P <br />~l <br />Revegetatinn Requirements -~ <br />Lt <br />J <br />E n Design end Certillcatlon Requirements- <br />~+-r Disposal of Excess Spoil , <br />O <br />© <br />Sediment Cgnlrol <br />n <br />1 Effluent Llmlts <br />F L <br />f <br />r <br />~ <br />R Q Hepolinp of Acid br Toxic Materials <br />~ <br />- <br />n~a- <br />~ Surface Water Monllorlnp <br />G u S Q Hignwall Elimination <br />-1- <br />v-~ <br />H ~ Ground Water Monltorinp T ©Downslope SAOiI D75posal <br /> <br />I n Blasting Procedures U ~ Post Mining Land Use <br />4+ <br />J y{~ Haul/Access Road Dasipn and Maintenance V ~l Cessation of Operations: Temporary <br />!jJ <br />`ate W ~ Other ~ _ <br />K ~ Refuse Impountlments <br />L ~ Other: Specify ._ <br />D15trIDUlIOn: Original ~ Field Office, Green ~ Headquarters, Blue - Stele's Copy. Yellow ~ Inspector's Copy. Pink. ~ File Copy IE " 763 (1183) <br />