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•; <br />_~s:' <br /> <br />~~~ <br />United States Department of the: • ~e to [lMATfON Di <br />SIGN For'Offic <br />e Use Only <br />Office of Surface ~ifii <br />Mine Site •Evaluati.on Inspection <br />. ofNatural' esour <br />~- <br />e~:, ,~T~ <br />Ilill <br />1m 1m <br /> Y Y M M Batcn Report <br /> a" <br />" 10. Date of Inspection <br />2. Name of Permiltee 9. MSHA Number (Y Y M M D D) <br /> <br /> <br />3.~Street Atldress 11. State Permit Number <br /> ~ o o f " X I ~ ~ ~ ~_ <br />4. City 5. State 12. Name of Mine <br /> 5 1 ! T t~ ~+A~v Ey ~ ~ <br />6. Zip C(fo~de 7. Ar~e`Ia Code 6. T7lephone Number 13. Coun`/ty Code 14. State Code. ~ 15. Strata 16. State Area Oflipe... <br /> »• <br />17. OSM Fleld 16. OSM Area '19. OSM 20. Type of Inspection 21;, Joii~fnspeclion 22. Inspector's ID <br />O11lfice No, Office No. Sample No. I(Code) .sti~ °~ 7e"s ~ IrN~o' " ~ <br />l <br />' <br />r <br />' No. <br />1L J <br />1 <br />l <br />l <br />- <br />- <br />S <br />J. •! <br />23. Status - able boves). <br />I Activity+(c~jeck'a <br />l <br />ic <br />24 <br />. T <br />ype <br />b <br />p <br />p <br />A m Type of Permit~C ~ILI •1 ~' - ~- <br /> A ~ Steep Slope E ~ Anthracite <br />B ® Mine Status (Code) -- ~ -;. ~ , <br />B ~ Mounts q:TOp; 8,emoval <br />F •"~ 'Federal Lands <br />C ; I Type of Facility (Code) <br />~ - :+'*~`~=" > j. <br />C ~ PrlmeFa(m'$ntls, ~ <br />G ~ Intlian Lantls <br />~T <br />D ~] Number'ift Permittetl Acres -l.''; <br />'~ <br />~ <br />-." Floors <br />D ~ AIIUVial <br />/alley H ~ Other <br />E n (~ D • !] Number-of Dislurbetl Acres ~ . <br />e <br /> ni. <br />..~.. .. <br />25. Performahce S[antlards (COtlesl ~ ~'".~''~ -~ <br />' <br />Instructions: Indicate compliance Cotle. For.any standartl marked• or 3 provide narrative.foq Qpp9rYthis determination. <br />Stentlerds 7ha1 Limit the Effec[s [o the Permi[ Area ~ Standards That Assi:C`eliecfametion Qualify and Timeliness- ' <br />A ~ Distance Prohibit) ins ~ M ~ Topsoil Handling <br />B ~ Mining Within Permit BountlarieBy~. N ~ Backl,illing and Gratling <br />C ~ Signs and Markers ~~ "-,':,+. ~-. O ~ FOllowirjg AecYa'mation Schedule <br />.~L.fra~lUr- <br />D ~ Sediment Control Measures ~ Sf~~. flY P ~ Revegefation~tequirements <br /> <br />E ~ Design and Cerllflcation Requirements- ~`r`W '~_ <br />O ~ Disposal ol'Ezcess~$poil. <br />~ <br />~ <br />~ <br />Sediment Control ~ <br />~ <br />- ~ <br />- <br />R ~ Handling of" AciG-pr-Tdiic Materials <br />F ~ Eflluent Limits <br /> <br />~ e up <br />G ~ Surface Water Monitoring ,~~+~ A.lairrA~t <br />~~. , <br />-~ ~" <br />5 ~ Highwall E(I~Dina,ion~ti' <br />~ ~ ~ <br />~ <br /> <br />' <br /> <br />H ~ Grountl Water Monitoring ~( ~P ;~(~' Spoil Disposal <br />T ~ D6wn51'ope <br />'"+•.,, ~. - <br /> <br />I ~ Blasting Procedwes ~ U . ~ Post MlninQ~ntl Use <br />•~ ~' ~ <br />~ <br />_ <br />nE <br />J <br />R <br />d D <br />i <br />ai V ~ Cessatio(~t•or"Operations: Temporary <br />~ ~ +'. <br />gn a <br />~ Haul/Access <br />es <br />•M <br />nte0ance <br />oa <br />- ~ <br />- <br />_ <br />W ~"Other -. _ ; <br />K ~ Refuse Impoundments - -, ri',:,;,"-~ <br />L ~ Other: Specify _ .. ~ > ~ ~^ <br />I Distrlbutlon: Original - I:leltl Office, Green ~ Headquarters, Blue <br />v <br />~ ' its. .- ..~. ~ 4 ~~ -.-. _ <br />~ ~A .... ~ III IIIIIIIIIIIII III <br />CEIVE '~ e~::;F~:: ,_ _ 999 _ <br />RE ~~~'~ - '° - .r - - <br />~° ` "~.~` Pege "1 of 2 Pagee <br />_ ~•2K <br />te's"Gopy; a Ipy~'.Inseec)or's Copy, Pink ~ File Copy IE ~ 163 (1/83) <br />~ : ~ ~ .. <br />4 'A • <br />Y, <br />t <br />%!~ <br />`~ <br />. ,~ <br />