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<br />III IIIIIIIIIIIII III <br />sss <br />Papa t of t Papw <br />United States Department of the Interior For Office Use Only <br />Office of Surface Mining <br /> <br />Mine Site Evaluation Inspection <br />Report ,a <br />~ ,b ,q <br />m m <br /> Y Y M M Bale Repon <br /> 10. Date of Inspection <br />2. Name of Permittee 9. MSHA Number (Y Y M M D D) <br /> <br /> 3. Street Address 11. Stale Permit Number <br /> <br /> 4. City <br />e <br />S~S <br />t~a'l 12. Name of Mine <br /> - ~~ <br />{I{ <br />~{r <br />W ~ _ I i" <br />fi. Zip Cotle 7. Area Code 8. Telephone Number 13. County Gotle 14. State Cotle 15. Strata 1fi. Slate Aree Ollice <br /> <br />17. OSM Field 1B. OSM Area 19. OSM 20. Type of Inspection 21. Joint InsDeclion 22. Inspector's ID <br />Ollice No. Ollice No. Sample No. <br />m (Code) Yes No No. <br /> <br />29. Status 24. Type of Activity (check applicable Dozes). <br />A ~ Type of Permrl <br />A Steep Slope <br />E ~ Anthracite <br />8~ Mine Status ICOtle) <br />B ~ Mountain Top Removal <br />F ~ Feoeral Cantle <br />C ~ Type of Facility ICOtle) <br />C ~ Prima Farmlantls <br />G ~ Intllan Lantls <br />D ~ ~ ~ ~- • ~ Number of Permittetl Acres <br />O ~ Alluvial Valley Floors <br />M ~ Other <br />E -" ~ -; • ,~' Number of Disturbed Acres <br />25. PeAOrmance Standards (Codes} <br />Inatruelbna: Intllcste compliance rode. For any standard marked 2 or 3 provide narrative to suDPOn This tleterminatlon. <br />Standards Thal LJmlt the Erletts to the Permit Area Stantlartls Tnat Assure Reclamation Ouallty ana Timeliness <br />A ~ Distance Prohibitions M ~ Topsoil Handllnq <br />8 ~ Mlnlnq Within Pemtlt Boundaries N ~ Backfillinq and Gratllnp <br />C Q Slqna antl Merksn O ~ Following Reclamatian Schedule <br />D ~ Sediment Control Measures P ~ Revegetation Requirements <br />E ~ Deslgn and Certlllcetlon Requlramenis- O ~ Disposal of Excess Spoil <br />Sediment Control <br />R ~ Handllnq of Atld or Toxic Materials <br />F ~ Elllusnt Llmlts <br /> <br />G a Surtsce Water Monitoring S a Mlghwall Elimination <br /> T ~ Downelope Spoil Dlaposal <br />H ~ Ground Water Monitoring <br />U a Post Mining Land Use <br />1 ~ Blasting Pracetluras <br /> V ~ Cessation al Operations: Temporary <br />J ~ Haul/Accasa Roatl Deslgn and Maintenance <br /> W ~ Other <br />K ~ Reluse Impountlmenis <br />L ~ Other. SDeelfy <br />4 <br />Distribution: Original -Field Office, Green - Neatlquaners, Blue ~ Slate's CoDY~ Yellow ~ Inspector's Copy. Pink -Fits Copy IE - ifi311183) <br />