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~ ~^:~~~:~,,~~~--, III IIIIIIIIIIIIIIII <br /> T <br />~C 1 i99C <br />United States Department of the I nterior For Offic e Use Only <br />Office of Surface Mining tJJined ~ and,a tb ,q <br />Mine Site Evaluation Inspection Report Reclamatio Diy is ~I; <br /> Y Y M M Balcn Repon <br /> t0. Gate qt Inspection <br />2. Name of Permittee 9. MSHA ;Dumber iY V M M D DI <br /> ~ ~ <br />L <br /> <br />3. Street Address t 1. Stales Permit Numb <br />r <br /> e <br />~ <br />4. Cily <br />5. State Nam? of Mine <br />t2 <br />.. I I I ~ <br />1 L I I I ~ I ~ ( <br />~ <br />~ i~ ~T~~~~! <br />6. Zip Cotle 7. Area Code 8. Telepnone Number 13. County Code 14. State Cooe t5. Strata tfi Stave Area OIIICe <br />_ -J ~ C <br />t7. OSM Field 18. OSM Area 19. OSM 20. Type o' rrspectron 21. Jginl Inspection 22 Inspector's ID <br />Otlice No. Ollice No. Sample No. (Cotle) Yes No No. <br /> <br />23. Status 24 Type M Actrvrty Ic'+ech applicptle cozesl <br />A m Type of Permit <br />A rl Steep Slope <br />E ~ Anthrarite <br />B m Mine Status tCbdet <br />B C Mou ni ain fop Remo.al <br />F [-1 Pod=rest Lantls <br />1 <br />C Type of Facility ICodel <br />~ C ~ Pnme Farm!antls G ~ rndian Lands <br />~ <br />~ <br />D ~ Number of Pe•mitted Acres <br />D ~ Alluwa! Valley Floors <br />H ~ Other <br />E ~~~ Number of Disturbed Acres <br />25. Pe•formance S'antlartls ICodesl <br />Inztruetlone Indicate xmpliance code. Fur any standard marketl 2 cr ~ provitle nanalive to support this determination. <br />Standards That Limit the EtIeCIS to the Permit Area Stantlards Thal ASSU'e Reelam3npn Ouahly and -~mol~re55 <br />A ~ Distance Prohibitions !d ~ Topsm! Hanolmq <br />B ~ Mining Wdhm Permit Boundaries N ~ Bach~illn.q and Grading <br />C ~ Signs and Markers O L J FOIIOwmg R?clamaYOn $C nodule <br />D ~ Sediment Control Measures P ~ Rzveye!abnn Requremenls <br />E ~ Design and Cerhlication Requirements- O ~ Disposes'. of Excess Spoil <br />Sediment Control <br />R ~ Handling of Acid or Toxic Materials <br />F ~ Effluent Limits <br />S ~ Wghwall Ehmmatwn <br />G ~ Surface Walar Monitoring <br />T ~ Down slope Spoil Disposal <br />H ~ Ground Water Monitoring <br />U ~ Post Mining Lantl Use <br />I ~ Blasting Procedures <br />V ~ Cessation of Operations: Temporary <br />J ~ Haul/Access Roatl Design and Maintenance <br />W ~ Other _ <br />K ~ Refuse Impoundments <br />L ~ Other: Spegily - <br />Distribution. Ongmal ~ Field Office, Green ~ Heatlquan ors. Biue Sate's COpY. yellow Inspector's Copy Pmt ~ Fdz Cppy IE ~ t63 hIB°) <br />