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For The Fol]~wing 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) dr Cessation Order (CO) issued, B = Inspected and both Comments noted 8 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 contnent section. GENERAL INSPECTION TOPICS: CORDS........... L Y / NA / ©/ R / V / B / T / S LCJ SIGNS AND MARKERS ................. l Y / NA / ®/ R / Y / B / T / S LCJ ROADS ............................. L Y / NA / N /Ce'~/ Y / B / i / S J LCJ HYDROLOGIC BALANCE ................ l Y / NA / N /®/ V / B / T / S LCJ BACKFILL & GRADING ................ L Y / ®/ N / R / V / B / T / S J LCJ EXPLOSIVES ........................ L Y / NA /®/ R/ V / B / T / S J LCJ PROCESSING WASTES ................. L Y / NA / N / ®/ V / B / T / S J LCJ SUPPORT FACILITIES ................ L Y / NA / N /®/ V / B / T / S J LCJ TOPSOIL ........................... L Y / NA / N / ®/ V / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCE...... L Y / NA / N / ®/ V / B / T / S LCJ FISH & WILDLIFE ................... L 1' / NA / ®/ R / V / B / T / S J LCj REVEGETATION ...................... L Y / NA / N / ~/ V / B / T / S J LCJ AIR RESOURCE PROTECTION........... L ©/ NA / N / R / V / B / T / S LC] SLIDES & DAMAGE ................... L Y / ~/ N / R / V / B / T / S ] LCJ SUBSIDENCE ........................ L Y / NA /®/ R / V / B / T / S LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L ©/ NA / N / R / V / B / T / S ] LCj OFFSITE SUPPOR7 FACILITIES........ L Y / NA / ®/ R / V / 8 / 7 / S J LCJ RECLAMATION SUCCESS ............... L Y / NA / ®/ R / Y / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... L Y /Q/ N / R / V / B / T / S (1) L20 (2) -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ NA / N /~/ V/ B/ T J (2) L.Q1YQ-8~~ o 82--------- LSpaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ Required Entry.