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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, 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: CORDS........... L Y /~ / N/ R/ V/ B/ T/ S LCJ SIGNS AND MARKERS ................. L Y / NA /~/ R / V / B / T / S LCJ ROADS ............................. L Y / NA / N / R / V / B / T / S LCJ HYDROLOGIC BALANCE ................ L Y / NA / N / R / V / B / T / S LC1 BACKFILL & GRADING ................ L Y / N / N //V / B / T / S LCJ EXPLOSIVES ........................ L Y/ N / N R/ V/ B/ T/ S ' LCJ PROCESSING WASTES ................. L Y / / N / R / V / B / T / S j LCJ SUPPORT FACILITIES ................ L Y/ N / N/ R/ V/ B/ T/ S J LCJ TOPSOIL ........................... L Y/ / N/ R/ V/ B/ T/ S LCJ GENERAL MINE PLAN COMPLIANCF_,.,,,, L Y / NA /~/ R / V / B / T / S J LCJ FISH & WILDLIFE ................... L Y / NA / N / R / V / B / T / S J LCJ REYEGETATION ...................... ~/ NA / N / R / V / B / T / S J LCJ AIR RESOURCE PROTECTION........... L Y /~ / N / R / V / B / T / S J LCJ SLIDES & DAMAGE ................... l Y / NA /~/ R / V / B / T / S J LCJ SUBSIDENCE ........................ L Y/ A/ N/ R/ V/ B/ T/ S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y / A / N / R / V / B / T / S J LCJ OFFSITE SUPPORT FACILITIES........ L Y / / N / R / V / B / T / S ] LCJ RECLAMATION SUCCESS ............... L Y/ N / N/ R/ V/ B/ T/ S J 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/ V/ B/ T J (1) L20 (2) -------------------- SDaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.