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Pape 2 of ~ Pages <br /> tad States Departmetat of the Inte~ <br /> Office of Surface Mining <br /> Mine Site Evaluation Inspection Report <br />28. State Permit Number 27. Date of Inspection <br /> YMMDD <br /> <br />28. Yqs No Do mining end reclamation ectlvltlea on the site comply with the plans In the permit9 <br />® ^ If no, rovlde nerrellve to su ort this determination. <br />29. Indicate number of complete and pertlal Inapectlone conducted by the State to date for this annual review period: <br />29a. ~ Number of Completes 29b. m Number of Pertlals <br />30. Indicate number of complete and pertlal Inspections required by the State during this annual review period: <br />30a. ©Number of Completes 30b. ~ Number of Pertlals <br />31. Hes Inspecllon frequency been met? <br />Yea No Yes No <br />31 a. ^ ^ Completes 31 b. ^ ^Pertlals <br />32. FEDERAL ENFORCEMENT INFORMATION. [Enter vlolatldn number. Check appropriate box(es]] <br />Ten-Day Notice No. Notice of Vlolatlon No. Cessation Order No. Vlolatlon Codes <br />A ^ ^ ^ Authorizations to Operate <br />B ^ ^ ^ Signs end Markers <br />C ^ ..................... ^ .,. .................. ^ ........................ Beckfllling and Grading <br />D ^ ^ ^ Highwall Elimination <br />E ^ ^ ^ Rills and Gullies <br />F ^ ..................... ^ ... .................. ^ ....................~.... Improper Fills <br />G ^ ..................... ^ ... .................. ^ ........................ Tapsoll Handling <br />H ^ ^ ^ Sediment Ponds <br />I ^ ^ ^ Effluent Limits <br />J ^ ..................... ^ ^ Water Monitoring <br />K ^ ^ ^ ........................ Buffer zones <br />L ^ ..................... ^ ... .................. ^ ........................ Roads <br />M ^ ..................... ^ ... .................. ^ ........................ Dams <br />N ^ ..................... ^ ^ Blasting <br />0 ^ ^ ^ ........................ Revegetation <br />P ^ ^ ^ Spoil on the Downslope <br />O ^ ^ ^ Mining Without Permit <br />R ^ ^ ^ Exceetling Permit Llmlts <br />S ^ ^ ^ Distance Prohibitions ' <br />T ^ ^ ^ Toxic Materials <br />U ^ ^ ^ Other Violations <br />33. Name of Authorized Representative (print or type) <br />Signature of Authorized Representative Date r ~ r <br /> ~ <~ ," ~, F <br />Signature. of-Reviewing Olflcl I <br />,.~ <br />1 ate ~ <br />~ ~, <br />„~, <br />,~_ <br />.~ z ~~k l <br /> ~. <br />Distribution: Original -Field Olflce, Green -Headquarters, Blue -Slate's Copy, Yellow - Inapeotor's Copy, Plnk -Fib Copy IE - 163 (t783) <br />