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<br />Pape 1 0l 2 Pages
<br />United States Department of the Interior a For office Use only
<br />Office of Surface Mining
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<br />Mine Site Evacuation InspAction`Repo~t~l c~vl
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<br />';nr.ll rimrli nrrLl__I/iigi'l rr'.,~ r; n',11I^ Fil'1 ol,}r1YC ISM If M.la•1 Balcr lriln`~i Repon -
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<br />2. Name 01 Parmittee~ 1 t I r '~ l " ~ ~ ~ ~~ ~ ~ ;~10. Dale of Inspection
<br />9. MSHA Number "~ ~' "`~ "'^~ ry y M M D D)
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<br />J. Slreel Addreaa hurl}f ~i IOl^!(i!Pp;) r135iei'1 1{.`Stele Permll Number~u vi~,rli^ 4 L'~rt+tt •`ll,l~7 ~h'+'" i~~~i•
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<br />~. Clt WA 1. ~,'~' C~S`~$lete i:n^~ 12. Heron of Mlne '4+ "i•11In T 7.11 (," -~ t .
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<br />B. Zlp Code 7. Arse Code 8. Teleph
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<br />umber 15
<br />Stra to 16
<br />Slate Area Olllce
<br />ounty Code 1d. Slate Code
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<br />17. OSM Field 18. OSM Area 19. OSM ~ 20. Type of lnspe^.Ilon 21. Jolnl Inspection 22 Inspector's ID
<br />Ollice No. Olllce No. Sample No. (Code) yes~ ,No, No r n
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<br />23. Status =~'rsa ~' 2U 1.24 Type bl Activity lcheck applicable coxed.
<br />A ® Type of Permit (t~F.~; 1;1L~If ~li'1 rtl~lll
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<br />C ®~ :. Type of facility (Code) ' B Mourdaln lop RenwYal F Fnderal Lend9
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<br />I'1 ~(~rrn~1~(~P!e,FBrmlandscT„`^,. ,.,,I"f G,,.C J.r71ntllBn Lenda7l
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<br />O • Number of Permitted Acres
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<br />E nf~nTnT~rTTrn Number of Dlalurbed Acres
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<br />Perlormence Slentlards (Codeal'
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<br />"'lit Inatruelbna: Indleate edmpllinee'codd.•Fdr any atanduA marked 7 ol'0'provltle nenellve In support this Oeterminellnn. ~i~'^~•'Ir: ~ ' " !1'
<br />Slanderda Thal Limit the Ellecte to the Permll Area I I k. Y.T I A ~'Slandertls Thit Asbure~'Re7:lerAallori OIlallty and'iimeilnass'•'r ~.
<br />A ~ Dlatants Yrohlblllona 9nf•n7 yflli~D M t ~ Topsoil Hantlling
<br />B ~ Mlnlnq Wllhln Permll Boundaries ~; lj'O_ 17rj f(ti.l I IO• Back!ilbnq antl Grading
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<br />O f Following Reclamation Schedule
<br />C ~ Signa antl Merkera
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<br />~, r`ird:"".,gym! 7p~hr1R 02n1R;1 F~
<br />D ~ Sediment pontrol,Meaaureei?~l nrlifrrp ! pP P ~ Reve9elallon Repulremenls h;-n-~7n lily !) f`^
<br />E ~ Design end Csrtlllcstlon RequlromenU•~'70)% ['.r O ~ Disposal of Excess Spoil fr•ri^ ;,: r4t:• ,!jn-.•7
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<br />Sediment Control {t~~
<br />10rI~~ 'fir R ~ Handllnq of ACltl~oi Toxic Material! 1'`7 •!'B rl ti i'^11 Ci
<br />F ~ Eltluenl Llmlla
<br />S ~ Hlghwall Elimination
<br />G a Surlaca Water Monltorlnp
<br />i'I Vi?7 gnrynT~r ©,Downalope Spoil Disposal
<br />H ©Ground Water Monltorlnp j '
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<br />Posl Mlnlnq Land Use
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<br />I ® Bleallnq Procedures
<br />V ~ Cesaatlon of Opereliona: Temporary
<br />J ~ Hau1lACCeaa Road Dealpn antl Malnienance •', Ilrli(li r;:1;1 11i
<br />W ~ Other
<br />K ORefuselmpoundmenta ---":•il.`~~I:jll'(?inl~T"t~
<br />L ~ Olhec Spxlly __ _____ ,~Ir1r;~riirt,lr 1 .'
<br />Distribution: Original ~ Field Olllce, Green ~ Headquarters, Blue ~ Slale'a Copy. yellow ~ Inspector's Copy. Pinh. ~ File CoDY IE - 16711/SJl
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