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For The Following Entries, Circle The Appropriate Choice: T = lnspeCLed and TOUnd In compliance, NA = Inspection Topic not applicable, N =Not Inspected, R =Inspected and Comments noted, V =Inspected and Violations (NOV) or 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 cortlnent section. GENERAL INSPECTION TOPICS: CORDS........... L Y / NA /~ / R/ V / B / T / S LCJ SIGNS AND MARKERS ................. L Y / NA / N /~ / V / B / T / S J LCJ ROADS ............................. L Y / NA / N / ®/ V / B / T / S j LCJ HYDROLOGIC BALANCE ................ L Y / NA / N /~/ V / B / T / S LCj BACKFILL 8 GRADING ................ L Y /~N~ / N / R/ V / B / T / S J LCj EXPLOSIVES ........................ L Y / NA /GN / R / V / B / T / S j LCj PROCESSING WASTES ................. L Y / N® / N / R / V / B / T / S j LCJ SUPPORT FACILITIES ................ L Y /~/ N / R / V / B / T / S ] LCJ TOPSOIL L Y / NA /Q / R / V / B / T / S ........................... LCJ GENERAL MINE PLAN COMPLIANCE...... L Y / NA / N /~/ V / B / T / S J LCJ FISH 8 WILDLIFE ................... L Y / NA /©/ R / V / B / T / S ] LCj REVEGETATION ...................... L Y / N~/ N / R/ V / B / T / S J LCJ AIR RESOURCE PROTECTION........... L N / NA / N / R / V / B / T / S j LCJ SLIDES 8 DAMAGE ................... LQ / NA / N / R / V / B / T / S LC] SUBSIDENCE ........................ LO / NA / N / R / V / B / T / S J LCJ EXCESS SPOIL 8 DEVELOPMENT WASTE.. L Y /~~ / R / V / B / T / S J LCJ OFFSITE SUPPORT FACILITIES........ L Y /~ / N / R / V / B / T / S LCJ RECLAMATION SUCCESS ............... L Y / N~ / N / R / V / B / T / S LCJ SPECIAL CATEGORIES OF MINING...... L Y NA / N / R / V / B / T / S J (1 ) (2) -------------------- 20 -------------------- Spaces (3) -------------------- Max] LCJ OTHERS ............................ L Y / NA / N / R / V / B / T zi ~o ~ D S u R v EY--------- Leo Spaces (3) -------------------- MaxJ NOTE: LCJ Required Entry.