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For The Following 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) ur Cessation Order (CO) issued, B =Inspected and bath Comments noted 8 Violations or Cessation Order issued, T 10 Day Notice lssuea by OSM Oversight Personnel, S =Sample taken and sent to the lab from analysis - describe type and location of sample taken under cortment section. GENERAL INSPECTION TOPICS: CORDS........... L Y / NA ~/ R / V / B / T / S LCJ SIGNS AND MARKERS ................. ~/ NA / N / R / V / B / T / S LCJ ROADS ............................. L Y / NA / N /~/ Y / B / T / S LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /®/ V / B / T / S J LCj BACKFILL 8 GRADING ................ L Y / NA / N /®/ V / B / T / S LCJ EXPLOSIVES ........................ L Y / NA /~ R / V / 8 / T / S J LCJ PROCESSING WASTES ................. L Y / NA /~ R / V / B / T / S LCJ SUPPORT FACILITIES ................ L Y / NA ~/ R / V / B / T / S J LCJ TOPSOIL ........................... L Y / NA /~ R / V / B / T / S J LCJ GENERAL MINE PLAN COMPLIANCE...... L~ NA / N / R / V / B / T / S LCJ FISH 8 WILDLIFE ................... ~ NA / N / R / V / B / T / S J LCJ REVEGETATION ...................... L Y / NA /~ R / V / B / T / 5 ] LCJ AIR RESOURCE PROTECTION........... L Y / NA /~/ R / V / B / T / S LCJ SLIDES 8 DAMAGE ................... L ~ NA / N / R / V / B / T / S LCJ SUBSIDENCE ........................ L Y / NA N/ R / V / B / T / S LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y / NA ~ R / V / B / T / S ] LCJ OFFSITE SUPPORT FACILITIES........ L Y /~/ N/ R / V / B / T / S J LCJ RECLAMATION SUCCESS ............... L Y / NA N / R / Y / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... 1 Y / NA / N / R / V / B / T / S J (1) L20 (2) -------------------- SDaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - LCJ OTHERS ............................ L Y/ NA ~/ R/ V/ B/ T J (1) L20 (2) -------------------= SDaces (3) -------------------- MaxJ - - - - - - - - - - - - - - - - - - - - NOTE: LCJ Required Entry. ~"