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raa~ ~ a : raq^s <br />United States Department of the Interior For Olflce L'se Only <br />Office of Surface Mining <br />Mine Site Evaluation Inspection Rep <br />ort 11 ,h ,~ <br />~ I -I l <br /> L~ I I I <br />Y Y M M 9a1Ch Regan <br /> <br />2. Name of PermHlea 10. Uale of Inspection <br />9 MSHA Number ~ (Y Y M M D D) <br />j. <br />,o c <br />k ~ z s <br />~ <br />jo <br />j <br />oj~ <br />ll <br />I <br />l~l <br />J~ <br />IpiS,-i0 <br />3il ;73i- <br />IG `I iC?I(c! <br />I !q~b <br />; <br />_ <br />_ <br />, <br />_ <br />_.. _ <br />! <br />I <br />] <br />/~ <br />,y <br />3. SVPPI Atltlress ~~l~YLI I1ih0 O' 11. StalE Perms Numcei <br /> <br />s, <br />o <br />G a <br />l t <br />~ <br />Ir <br />>7 <br />t ~~''~~ I <br />•~_ o T' I~ ~ ~J_L1J_L_L <br />~ City t Q ~~ 5. Stale <br />v r ~ 12 Nam? of Mine <br />f ~r a SIS ~ 13 i t i~~ <br />6. Zlp Code 7. Area Code 8. Telephone Numbe~~ <br />o a ~ 9 - ~ ~~ 13. County Code .State Code - 15~~Strata It~State Area Or/ice <br />~I~ <br />i I ~ ~ ~ <br /> L.L~ <br />17. OSM Field 18. OSM Area 19. OSM 20. Type of Ir.speotior 21. Joint Inspection 22 Inspector's ID <br />Ollice No. IOllice No. Sample No (Cotle) Yes Nc Ho. <br />i~ <br />- i .1: <br />~ i ~ ~~-~ <br />b ~. <br />23. Status 2d Type M AClrvily Ic?ecF applirab~e COVe^,I. <br />A ~ Type of Perm~l I_. <br />A Lj Steep Slope E ~ Anlhraotle <br />B m Mine Status ICode) 1 <br />R CI Mow~lam r~u Ren•o.al F ~ <br />I r=tlei a! Lantls <br />C ~ Type o1 Facility (Code) _ . <br />'_ <br />C LJ Puma Farm!a ntls G I I InCian Lan^_s <br />L J <br />D D Q 8 Q • Number of Permltte0 Arras D ~ Alluvial Vall9y Floors H }~ Other <br />Y ~ <br />E I G ~ '~ • G Number al Disl urbed Acres Yriv La <br />25. Pe~tormancP S'anoard° ICodes` <br />Inslruetlon•: IndicalP compliance code For any standard marked 2 c~ 3 provide nartalrve In supDal Ides tlererminaunn <br />Slantlartls Thal Limit the EIIec IS to the Permd Area Standards That ASSU•e ReC~a.m3ligr. Oua~ny and Tinie!!ress <br />A ^ Distance PfOhibitiOns \I I_J TOp50•~ Handling <br />8 ~ Mining Wdhin Permrl Bomtlanes N ~ Backblbnq anc Grading <br />C ~ Signs and Markers O L Fe!IOle~ny Reclanial~on Stlrenvle <br />D ~ Sediment Control Measures P ~ Reveyetabnn Requirements <br />E ~ Design antl Certillcatlon Requirements- O ~ DISDOSaI of Excess Spoil <br />Sediment Control <br /> <br />F ~ Elfluent Llmlis <br />R ~ Hantlling of Acid or Toxic Materials <br /> S ^ Highwalt Elimination <br />G ~ Surface Water Monitoring <br />T ~ DownsloDe Spoil Disposal <br />H ~ Ground Water Monitoring <br />U ~ Post Mining Land Use <br />I ~ Blasting Procedures <br />V ~ Cessation of Operations: Temporary <br />J ~ Haul/Access Road Design and Maintenance <br /> <br />K ~ Reluse Impoundments W ~ Other ___- <br />L ~ Other: Specify <br />Distribution: Original ~ Field Olllce, Green ~ Heatlquaners, Blue ~ Slate's GODY~ Yellow -Inspector's Copy. Pink ~ File Copy IE ~ 163 (11&3) <br />