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<br /> <br />Pepe 1 or Z Papee <br />United States Department of the Interior For Office Use Oniy <br />Offil:e of Surface Mining <br />Mine Site Evaluation Inspection <br />Report ,a <br />~ tb ,~ <br />; 7~ <br /> Y V M M Ba1Cn Raporl <br /> t0. Date of Inspection <br />2. Name of Permittee 9 MSHA Number (Y Y M M D O) <br /> ~ ~ i I ~ I <br />3. Street Adtlre55 1 Slate PP <br />u m <br />1 <br />ermil N <br />b <br />e i <br /> ~ <br />y~T <br />r~ <br />X~ <br />l~ <br />il <br />ll <br />L_L-L-LyI_-L_J_11I _ <br />~I <br />4 City 5. State t2. Name of Mine <br /> _ <br />6. Zlp Code 7. Area Cotle 8. Telephone Number <br />= - 17. County Code 1a~Stalte Coue ;~tSm~Slra~ta <br />~ W '`LJ t6. Slate .4rea Ofllce <br />17. OSM Fleltl [6. OSM Area tg. OSM 20. Type of Ir.spechor 21. Joint Inspection 22 Inspector's ID <br />Olllce No. Office No. Sample No. (Cotle) Yes r.lp No. <br /> <br />23. Status 24. Type M Aclrvify (q'+eck applicable pox25) <br />A m Type of Permit <br />A ~ S(eep 5100¢ <br />E ~ ~ AnlNacite <br />B m Mine Status ICodel ~I <br />B u MOprll ain lop Removal <br />u _ <br />F i ~ Fodoral Lands <br />C Type of Facility (Code) <br />m C ~ Prime Fxrm sands G ~~ Indian Lands <br />D ~ Number of Permitted Aires <br />~r r-I <br />D I I Alluvial Valley Flpors <br />u <br />M ~ Other <br />E I I I I I I' I ~ Number of Disturbed Acres <br />25. Performance Standartls ICodesl <br />Inarrudlonc Intllcate compliance code. For any standard marked 2 c~ 7 provide na;ral,ve to support frus Oetermmabon. <br />Standartls Thal Limtl the Effects to the Permit Area Stantlaftl5 That ASSPe ReGam al•,on Ounlny and Timeliness <br />A a Distance f•rohibgions M U ToDSOd Handlmp <br />B ~ Mining Within Permil Bountlanes N ~ Backnll~nq ano Grading <br />C ~ Signs antl Markers O ~ Following ReUania lion Sc hed~lle <br />J <br />D ~ Sediment Control Measures P ~ Reveye!a non Regwrements <br />E ~ Design and Certification Requnements- O ~ Oisposal of Excess Spod <br />Sediment Cgnilgl <br /> <br />F ~ Effluent Llmils <br />R ^ Hantlling of Agid or Toxic Mdlerials <br /> <br />G ~ Surface Water Monitoring S ~ Hig nwall Elimination <br /> <br />H ~ Ground Water Monitoring T ^ DOwnslope Spoil Disposal <br /> <br />1 ~ Blasting Procedures U ~ Post Mining Land Use <br />~t <br /> <br />J ~ HaullACCess Road Design and Maintenance V I I ies5alion of Operations: Tempgrary <br />`.l <br /> <br />K ~ Reluse Impoundments W ~ Other <br />L ~ Other: Specdy ____ .__ __ <br />Distnbwwn Onginal ~ Field Ol bce. Green ~ Heatlquarters. Blue SlateB Copy. yellow ~ Insuecmrs Couv PmM Flle Copy IE t631v671 <br />