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For The Following Entries, Circle The Appropriata Choice: = nspec e an oun in co-np~rance, NA _ Inspection Topic not applicable, N = Nit Inspected, R Inspected and Comments noted, Y = Inspected and Violations (NOVI dr Cessation Order (C01 issued, B = Inspected and both Comments noted 8 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/ NA / N /(~/ V/ B/ T/ S J LCJ SIGNS AND MARKERS ................. L U / NA / N / R / V / B / T / S J LCJ ROADS ............................. L U/ NA / N/ R/ V/ B/ T/ S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /lg~/ V / B / T / S 1 LCJ BACKFILL 8 GRADING ................ L ~ / NA / N / R / V / 8 / T / S J LCJ EXPLOSIVES ........................ L n/ NA / N / R / Y / B / T / S J LCJ PROCESSING WASTES ................. L Y / ~ / N / R / Y / B / T / S J LCJ SUPPORT FACILITIES ................ L~j/ NA / N / R / V / B / T / S ) LCJ TOPSOIL ........................... L ® Y~NA / N /(ftj/ V / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCF_...... L ~f / NA / N / R / V / B / T / S J LCJ FISH 8 WILDLIFE ................... L ~/ NA / N / R / V / B / T / $ J LCJ REVEGETATION ...................... L Y / NA / N / ®/ V / B / T / S J LCJ AIR RESOURCE PROTECTION........... L C~/ NA / N / R / V / B / T / S J LCJ SLIDES 8 DAMAGE ................... L Y / N~ / N / R / V / 8 / T / S J LCJ SUBSIDENCE ........................ L Y / ~/ N / R / V / B / T / S J LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Lj/ NA / N / R / Y / B / T / S J LCJ OFFSITE SUPPORT FACILITIES........ L Y / 1~ / N / R / V / B / T / 5 J ICJ RECLAMATION SUCCESS ............... L Y / Gel/ N / R / V / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... L Y / ~ / N / R / Y / B / T / S J (1) L20 (2) -------------------- Spaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y / NA / N / ®/ V / 8 / T ] (2) ~c> .SLCZi--------------= LSPaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - NOTE: LCJ = Required Entry.