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r} •, ~ <br />~~.~ 1 ° <br />n ~ III I II I II I II IIII III 0a 1 0l t PaOaa <br />IFRS lit"' N'-+a'~" N ~ 6 ~ 999 <br />United States Department of the`Interior NQV 1 Q ~ 8~ For Office Use Only <br />Office of Surface Mining <br /> <br />Mine Slte Evaluation Inspection <br />Report' ' MINED ,e <br />ND ,b ,~ <br /> RECLAMATION DIV~ m m <br />' ~ Y Y M M Batch Repon <br /> 10. Dale of Inapectlon <br />2. Name of Parmlttee B. MSHA Number (r Y M M D D) <br /> I O - a - 67 - <br /> 3. Street Addres9 11. Slate Permit Number <br /> r <br />d. Ciry <br />5 <br />S <br />t <br />ale 12. Name of Mine " <br /> m <br /> r 5 } ^ <br />~ <br />rJ ~ <br />J ~ ~ r ~ ~ v1 1 _ <br />8. ZI Cotle 7. Area Cade 8. Telephone Number 13. County Cotle 16, State Cotle 15. Strata <br />m m I16~Slate Area Office <br />W <br />17. OSM Field 1B. OSM Area 19. OSM 20. Type of Inspection 21. Joint Inspecllon 22. InaDector's ID <br />J'O~lliJmcs~NO. Olllcs No. Sample No. <br />w r t <br />~ ~ ~ ~ (Cotle) Yes No <br />~ " No. <br />1~ <br />23. Statue ~ 26. Type of Activity (check applicable boxes). <br />A Q~ Type of Parmlt <br />A ~/I Steep Slope <br />K~ <br />E ~ Anthracite <br />B ® Mine Status (Code) ~ B ~ Mountain top Removal F ~ Federal Lentls <br />C ~ Type of Facility (Code) <br />C ~ Prime Farmlantls <br />G ~ Intlian Lands <br />D O `~ ~ O • Nurpber of Permiltetl Acres <br />' <br />D ~ Alluvial Valley Floors ~ <br />H ~ Other <br />E O p 7J • Number of Dlaturbed Acrea <br />25. Performance Slentlams (Codes) <br />Ngruelbna: Indicate compliance Dods. For any stantlard merketl 2 or 3 provitle narrative to support ihla determination. <br />Standards That Limll the Ellects to the Parmlt Area Standards That Assure Reclamation Oualily and Timeliness <br />A ~ Distance Prohlbitlona M ~ Topsoil Handling <br /> <br />B ~ Mlning Within Parmlt Bountlarlea ~ ~ r,. <br />N ~ Backfilling antl Grading <br />C ~ Slgna antl Markers ~ O ~ Fallowing Reclamation Schedule <br />D ~ Sediment Control Measures P ~ Revegetatlon Requirements <br />E ~ Deelgn end Certlllcatlon Requirements- O ~ Disposal of Excess SDOiI <br />Sediment Control <br />R ~ Handllnp of Acid or 7oxlc Materials <br />F ~ Ellluent Llmite <br />S ~ Highwall Eliminalion <br />G ~ Surlaca Water Monitoring <br />T m Downslope Spoil DlapOaal <br />H ~ Ground Water Monitoring <br />U ~ Post Mlning Lantl Use <br />I ~ Blasting Prooedurea ' <br />V Cessation of Operations: Temporary <br />J ~ NeullACeeaa Roatl Design end Maintenance <br /> <br />K ©Refuae Impoundments Got..) r 5 ~' o ~ W Other <br />- <br />1ije~cA~ <br />L ~ Other. Specly <br />DlstrlbuNOn: Orlglnal -Field Olllcs, Green - Headquarlera, Blue ~ State's Copy, Yellow - Inspecta's Copy. Pink - Fila Copy IE - 76311/&7) <br />