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<br /> Wiled States Department of the Ir. .ior <br /> Office of Surface Mining <br /> M ine Site Evaluation In=portion Report <br /> <br />26. Stale Permit Number 27. Date of Inspection <br /> (YYh1 M DDj <br /> <br /> <br />28. Yes No DO mining and reclamation activities on the site comply with the plans in the permit? <br />n r If no, provide na rrative to support this determination. <br />29. Indicate number of complete and partial inspections conductetl by the State tc date for Ihis annual review period: <br />29a. m Number of Completes 29b. m Number of Parllals <br />30. Indicate number of complete and partial Inspections requiretl by the State during thi s annual review period: <br />30a, m Number of Completes 30b. ~ Number of Parhals <br />31. Has inspection hequency been met? <br />Yes Ho Yes No <br />31a ^ ^ Completes 31 b. ^ ^ Partials ... <br />32 FEDERAL ENFORCEMENT INFORMATION. [Enter violation number. Check appropriate box(es)) <br />Ten-Day Notice No. Notice o} Violation No. Cessation Order No. Violation Codes <br />A ^ ^ ^ Authorizations to Operate <br />B ^ ^ ^ ................. ....... Signs end Markers <br />C^ ^ ^ ~ Backfilling and Grading <br />D ^ ^ ^ Highwell Elimination <br />E ^ ^ ^ Rills and Gullies <br />F ^ ..................... ^ ^ Improper Fills <br />G ^ ^ ^ Topsoil Handling <br />H ^ ^ ^ Sediment Ponds <br />t ^ .............. <br />...... ^ ... .................. ^ ................. ....... Effluent Limits <br />. <br />J ^ ^ ^ ...... ........... ....... Water Monitoring <br />K ^ ^ ^ ................. ....... Buffer Zones <br />L ^ ..................... ^ ... .................. ^ ................. ....... Roads <br />M ^ ..................... ^ ... .................. ^ ................. ....... Dams <br />N ^ ..................... ^ ^ Blasting <br />O ^ ^ ^ ................. ....... Revegetation <br />p ^ ^ ^ . ......... . . . .. . . . . . . . . . SPoil on the Downslope <br />p ^ ..... ................ ^ ^ Mining Without Permit <br />R ^ ^ ^ ................. ....... Exceeding Permit Limits <br />S ^ ^ ^ ................. ....... Distance Prohibitions <br />T ^ ^ ^ ................. ....... Toxic Materials <br />U ^ ^ ^ Other Violations <br />33 Name of Aulftarimd Representative (print or type) # 34. Administrative Information <br /> i <br />P <br />it R <br />H <br /> D a ours) <br />erm <br />ev <br />ew ( <br />• O <br />Si naWre of Aut ed epresentattve ate <br />~ b ®. Travel Time (Hours) <br />Signature of Reviewing Off lal Dat c 0 • Inspection Time (Hours) <br /> <br />)'~~ r <br />B c <br />d <br />Q • Report Writing Time (Hours) <br /> <br />D~rlian Qgtrwl ~ Field Office, Green' Meadquaders, Blue • Stele's Copy, Yellow ~ Inspector's Copy, pink -File Copy IE ~ 163 f1fa31 <br />