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For The Following Entries, Circle The Appropriate Choice: = nspec a ari oun in comp lance, NA = Inspection Topic not applicable, N = Not Inspected, R Inspected and Comments noted, V =Inspected and Violations (NOV) or Cessation Ortler (CO) issuetl, B =Inspected antl both Comments noted & Violations or Cessation Ur der 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 / ®A / N / R / V / B / T / S ] lC1 SIGNS AND MARKERS ................. L Y / 1~ / N / R / Y / B / T / S ] LCJ ROADS ............................. L ® / NA / N / R / V / B / T / S LCJ HYDROLOGIC BALANCE ................ L Y / NA / N / ® / V / B / T / S j LCJ BACKFILL & GRADING ................ L Q~ / NA / N / R / V / B / T / S ] LCJ EXPLOSIVES ........................ L Y /® / N / R / V / 8 / T / S J LCJ PROCESSING WASTES ................. L Y / ~ / N / R / Y / B / T / S J LCJ SUPPORT FACILITIES ................ L Y / ~ / N / R / V / B / T / S ] LCJ TOPSOIL ........................... L Y / ®/ N / R / V / B / T / S ] LC] GENERAL MINE PLAN COMPLIANCF_,,,,,, L Y / ® / N / R / Y / B / T / S ] LCJ FISH & WILDLIFE ................... L O / NA / N / R / Y / B / T / S ] LCJ REVEGETATION ...................... L Y / NA / N /®/ V / B / T / S ] LCJ AIR RESOURCE PROTECTION........... L Y / @ / N / R / V / B / T / S ] LCJ SLIOES B DAMAGE ................... L Y / ~ / N / R / V / B / T / S ] LC] SUBSIDENCE ........................ L Y / ®/ N / R / V / B / T / S J LCJ EXCESS SPOIL & DEVELOPMENT WASTE.. L Y / ~ / N / R / V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y / ® / N / R / V / B / T / S ] LCJ RECLAMATION SUCCESS ............... L ~ / NA / N / R / V / B / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... L Y / ® / N / R / V / B / T / S ] (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y / NA / N / dt / Y / B / T J (2) Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - N07E: LCJ = Required Entry.