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ti II-~ <br />Pepe t of 1 Papea <br />United States Department of the Interior :~inoc L <br />Office of Surface Mining =?2clamation <br />Mine Site Evaluation Inspection Report <br />2. Name of Permillee <br />3. Street Address <br /> <br /> <br />4. City 5. State <br /> ~ <br />6. Zip Cotle 7. Area Cotle B. Telepho <br />tuber <br /> <br />For Office Use Only <br />1a 1b lc <br />Y v M M Batch Repon <br />1g. Date of Inspection ~' <br />9 MSHA Number (V Y~~M M D D) <br />~~~~' <br />11. Slate Permit Number ~ ~I <br />~! LL ~L <br />t2. Name of Mine ~ <br />~- ~~IIIZI-] ~~~ <br />13. County Cotle t4. State Code 15. Strata 76. Slate Area Otlice i' <br />~~ u <br />17. OSM Field 76. OSM Area 79. OSM 20. Type o1 icspeclior 27. Joint Inspection ?2 Inspector's ID ; <br />Office No. Office No. <br />~ Sample No. <br />~ (Cotle) Yes Noll <br />~ ~ <br />~ No. <br />m i I <br /> <br />23. Slalus ---- <br />24. Type ei Act wiry (c'+eck applicable coxes). <br />~ <br />I <br />/TI I <br />A <br />Type of Permit I <br />_ <br />W A ~ Sleep Slope I <br />E ~J Anthracite <br />B m Mine Status ICotlel _ <br /> B ~ Mownam fop Removal r <br />F ~ Federal Lantls <br />C m Type of Facility (Cotle) <br /> C ~ Pnme Farmlands G [, radian Lantls <br />D ~° Number of Permdtetl Acres <br /> D ^ Alluvial Valley Floors H ~ Other <br />E ~ oT l Number of Disturbetl Acres <br /> 25. Performance Standartls (Codes) <br />Inpirucibnp: Intllcate compliance cotle. For any stantlartl marketl 2 or 3 provi de na rrat rve In support This Oeterminali~n <br />Stantlards That Limit the Ellecls to the Permit Area sta ntlartl; Tnat Assu•e Rec~amation Dunlily and Timeliness <br />A ~ Distance Hrohibition5 M ~ Topsou Hanolinp <br />B ~ Mining Wlihin Permit Boundaries N ~ Backlit) u~q aritl Grading <br />C ~ Signs ano Markers O ~ Following Reclamation Scueu~ile <br />D ~ Sediment Control Measures P ~ Reveyelauon Requirements <br />E ~ Design end Certification Requirements- O ~ Disposal of Excess Spoil <br /> Sediment Control <br />R <br />~ <br />Hantlling of Acid or Toaic Materials <br />F ~ Ellluant Llmlis <br />S <br />~ <br />Highwall Elimination <br />G ~ Surface Water Monitorlnp <br /> T ~ Downslope Spoil Disposal <br />H ~ Ground Water Monitoring <br />U <br />~ <br />Post Mining Land Use <br />I ~ Blasting Procetlures <br /> V ~ Cessation of Operations. Temporary <br />J ~ HaullACCess Roatl Design and Maintenance <br /> W Other _ _ _._-_ _-__ _ _ __ <br />K ~ Refuse Impountlmenis <br />L ~ Other: Specify <br />DIa1rIDUtIOn: Original ~ Fielo Ollice, Green ~ Headquarters, Blue ~ State's Copy. Yellow ~ Inspecloi s Copy Pink Fue Copy IE t63 (1r6J) <br />