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For The Following Entries, Circle The Appropriate Choice: = nspec a an oun in comp lance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, V =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: CORDS........... ~ NA / N / R / V / B / T / S ] LCJ SIGNS AND MARKERS ................. L U/ NA / N / R / V / B / T / S ] LCJ ROADS ............................. L Y/ NA / N/ R/ V/ B/ T/ S J LCJ HYDROLOGIC BALANCE ................ L / NA / N / V / B / T / S J LCj BACKFILL & GRADING ................ ~Y / NA / N / R / V / B / T / S J lC] EXPLOSIVES ........................ Y / NA / N / R / V / B / T / S j LCJ PROCESSING WASTES ................. L Y / NA / N / R / V / B / T / S j LCj SUPPORT FACILITIES ................ L Y / NA / N ~/ V / B / T / S ] LCJ TOPSOIL ........................... / NA / N / R / V / B / T / S J LC] GENERAL MINE PLAN COMPLIANCE...... Y / NA / N / R / Y / B / T / S ] LCJ FISH & WILDLIFE ................... L Y / NA / N / R / V / B / T / S J LCj REVEGETATION ...................... Y / NA / N / R / V / B / T / S ] LCJ AIR RESOURCE PROTECTION........... L /~/ N / R / V / B / T / S ] LCJ SLIDES & DAMAGE ................... / NA / N / R / V / B / T / S J LCJ SUBSIDENCE ........................ Y / NA / N / R / V / B / T / S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. Y / NA / N / R / V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y NA N/ R/ V/ B/ T/ S J LCJ RECLAMATION SUCCESS ............... Q/ NA / N / R / V / B / T / S ] LCj SPECIAL CATEGORIES OF MINING...... L Y / NA / N / R / V / B / T / S J (1 ) L20 (2) -------------------- Spaces (3) --------------------_ Max] LCJ OTHERS. L Y/NA/N/R/Y/B/T J (1) L20 - - - - - - - - - - - - - - - - - - - - (2) Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.