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*rP<~ M1O`lNF2 ~ III IIIIII~II~~IIIII <br />a . ~-.. 9 U. S. DEPT. OF THE INTERIOR 999 <br />- ~ ~jw a, <br />'OFFICE OF SURFACE II~E !~,ATIONAND ENFORCEMENT: ° t;~ <br />4~R'CN a ;•~' Mine-Site Evalu~ion Inspection Report ~'°F~,,,~,w;i2/ <br />~~~ <br /> 10. Type <br />I.Permittee/Person <br />~ti 9 Permit Number <br />L., c _ a. Permit b. RA <br /> i ! 0 9 L G o P L. ~„_ F ;i. '' ! - o ff <br /> <br />2. Address 11. Inspection Date 12. Inspection Type 13. Join[ Inspection <br />P. ? e a ~- om- 5 a ~ ~ YiN <br /> NM OD - rr <br />3. Ci[y 4. State 14. Permit Status 15. Site Status 16. Facility Type <br />U K n1 O <br />5. Zip Code 6. Phone Number 17.OSM Office # 18. RSI # 19. Land Code <br />I ° -~ ~-~-~ ~ O o <br />7.Operator if Different than Permittee 20. M.S.H.A. ID # 21. State Code 22. County Code <br /> Dm-0~ G6 mo <br /> _ <br /> 8. Mine Name 23. AVS Permittee Entity ID Number <br /> I o D $ <br />= 24. Performance Standard Categories <br />Codea: l=Compliance, 2=Noncompliance, 8=Not Planned, 4=Not Started, b=Noncompliance Identified Elsewhere <br />A. Administrative D. Baelcfilling & Grading IL -Subsidence Control Plan <br />1. Mining within Valid Permit l.~aposed Openings <br />L Roads <br />2.~Mining within Bonded Area 2. '/ Contemporaneous Reclamation <br />3. Terms & Conditions of Permit 3 ~AQproximate Original Contour 1.Lltoad Cotutntcdon <br />4.1Liability Insurance 4I3tghwall Elimination 2. Certification <br />S.~,Owttership and Control 5. Steep Slopes (includes downslope) 3 Drainage <br />i <br />ntenance <br />6.~Temporary Cessation 6. Handling of Acid & Toxic Materials a• Sttrfacing and Ma <br />7.ZStabilizatian (rills and gullies) S.~Reclamation <br />B. Hydrologic Balance <br />1.~Drainage Control & Excess Spoil Disposal J. Signs & Markers <br />1 <br />/Signs <br />. <br />2. Iacpections & Certifications 1.,,~Placement <br />2 <br />ZMarkers <br />. <br />3./ Siltation Structures 2.~ Dtaittage Conuol <br />4.71hscharge Structures 3.~Stvface Stabilization IZ ,~ Distance I'robibitions <br />' <br />5 7 <br />Diveasioos 4„~Inspections & Certifications <br />6~EHluent Limits L. Revege~ation <br />Coal hTine Waste <br />F <br />. <br />1 X Vegetative Cover <br />7. Gmund Water Monitoring <br />8~Sttrfatx Water Motitoring (Refuse Piles/Impoundmmts) 2.~' Timutg <br />9 / Ihaioage -Acid-Toxic Materials 1.~Drainage Control <br />IO.LTImpoundments 2. Surface Stabtltzauon M.,~Postmiaing Land Use <br />11.~StreamBufferZones 3~Placemeat <br />4 Itrspections and Certifcations N. Other <br />C. Topsoil & Sabseil 5„~Impotttrdmg Struchtres <br />~ <br />1) <br />1 3 Removal <br />- <br />~los! ~~ ~) <br />3 Substitute Matuials G. Use <br />3..,~Storage and Protection ~ CutiH <br />2 <br />4~ltedimibution ce t3ofubitioos <br />3„~~last Stnvey/Schedule ~) <br />4,~Wamings & Records <br />S.,~Control of Adverse Effects <br />25. Inspection Frequency 26. Inspection Hours 27. Bonded Ames 28. Acres <br />aoazemtast ~ ®_~ <br />~Ntpe bn~~e 0 7 ~ r ~/ 01 <br />®o p~ e. Pmnit Review <br />.~ ° <br />~ L Tbaoded <br />Fraryme~ far prerkaa! Calendar Qtrs <br />hNombcr of Nvmbv o[ ~ <br />d O ( <br />. O b <br />T <br />~ <br />~ ~ . <br />0 b. Pk~ase I <br />~ <br />~ ~~~ t Pr~it[od <br />tryaimd camplue <br />oaa>plae p y mrpeeiioas m ~ <br />. on <br />ime <br />• <br />~ releasod <br />. I I t t t7t.~ b.Dishttbed <br />L-1~JJJ <br />mrpeNOaa ooaduaed O O <br />a c. Travel Time ~ <br />~~'r <br />l <br />udII (Fitimafed) <br />e N®ber of Number of <br />aired p <br />®amoa~daGeds 0 0 <br />xL <br />c~ ~ <br /> <br />O^ d Report Writing <br />o I . <br />e <br />ea <br />"~~~~ <br />~ <br />~d~l~~ <br />/ <br />pa <br />e 1 of f~ <br />m <br />p <br />Oas ~ . g <br />