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<br />• <br /> f ~ P•ll• 1 0l , P•ptl <br />III I I I I II I I I IIII III <br />999 R <br />United States Department of the . <br />Inter~or ~~+ ~Vor Office Use Only <br />Office of Surface Mining <br />Mine Site Evaluation Inspection Rep ~U( <br />~ <br />~( ~ <br />u <br />~ ,D ,~ <br /> <br />m m <br /> ~~p~, <br />` <br />~ <br />y <br /> / <br />~~~. Y Y M M <br />a, ~"~A(~ B•tth Hepon <br />• ~ /,~~,9•, <br />~~ <br />~rY 10. Date of Inspection <br />2. Name of Permittee 9. MSHA Numbsr <br />ir! (Y Y M M D D) <br /> <br />1 <br />1 <br />e <br />l1 <br />U <br />~ <br />/ <br />~~ <br />~ 5l <br />~ <br />(~ <br />~ '~ <br />3. Street Adtlrese 11. Stale Permit N <br />u <br />mber <br /> / ~ rr <br />~~ <br />L <br />4. City 5. State f2. Name of Mine <br /> 1 r ~ N ^ ~ n - <br /> , e . <br />ber <br />7. Area Code S. Telephone Num <br />8. Zlp Code 13. Counly Cotle 14. State Cotle 15. Strata 16. Slate Area Office <br />// <br />7 <br />l ~ Cr ® r I ! r~ J2 C~ m <br />17. OSM Field 1B. OSM Area 19. OSM 20. Type of Inspection 21. Jalnt Inspection 22. Inspector's ID <br />Olflce No. Ofllce No. Sample No. (Code) Yes No No. <br />23. Statue 21. Type of Activity (check epplicehle boxesf. <br />A ~ Type of Permit <br />A ~ Steep Slope <br />E ~ Anthracite <br />g ~ Mine Status (Code) <br />e ~ Mountain Top Removal <br />F ~ Federal Lands <br />C ~ Type of Facility (Code) <br /> <br />- <br />C ~ Prime Farmlands <br />G ~ Indian Lantla <br />, • Number of Permlttetl Acres <br />D <br />D ~ Alluvial Valley Floors <br />H ~ Other <br />E / • (~ Number of Dlsturl»tl Acres <br />25. Performance Stantlartls (Codes) <br />In•Iruetbna' Indicate compliance code. for any etantlard marked 2 or 3 provitle narrative to support this determinatlon. <br />Standartle That Limit the Effects to ihs Psrmlt Area Standards Thal Assure Reclamation Duallly antl Timeliness <br />A ~ Distance Prohibitions M /~ Topsoil Hentlling <br />B ~ Mlnlnp Wlthln Permil Bountlarles N ~ Backfllllnp and Gratlinp <br />C ~ Sipna antl Markers O j~ Following Reclamation Schedule <br />D f~ Sediment Control Measures P ~ Revepetallon Requirements <br />E ~ Dealpn antl Cerllflcatlon Requirements- O ~ Disposal of Excess Spoil <br />Setllment Control <br />R © Hentllinp of Aold or Toxic Materials <br />F ~ Eflluent Llmlte <br />S J~ Hlphwall Ellminatlon <br />G ~ SuAece Water Monitoring <br /> <br />H ~ Ground Water Manltorinp T ~ Downslope SDOII Disposal <br /> U © Post Mlnlnp Lantl Use <br />I ~ Bleating Procstlures <br />V ~ Cessation of Operations: Temporary <br />J ~ HaullAeeeee Roatl Deslpn antl Melntenence <br /> <br />K ~ Reluse Impoundments W ~ Other <br />L ~ Other. Speclty <br />Distribution: Original -Field O/tics, Green -Headquarters, Blue -State's CppY, Yellow ~ Inspector's Copy, Plnk -File Copy IE - 18311/93) <br />