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Page 1 011 Pagea <br />United States Department of the Interior For Office Use Only <br />Office of Surface Mining <br /> <br />Mine Site Evaluation Inspection <br />Report ,a ,b ,p <br /> Y Y M M Bdlt~ Report <br /> <br />2. Name of Permittee <br />9. MSHA Number 10. Dale of Inspection <br />(Y <br />Y <br />MM <br />D D) <br /> ~ <br />I <br />I <br /> <br /> 3. Sheet Atldress 11. Slate Permit Number <br /> <br /> <br /> 4. City 5. Stale r2. Name of Mine <br /> <br />~ ~ , - J__1~ _ <br />~ZJ_~ <br />6. Zlp Code 7. Area Code 8. Telephone Number 11 County Code 14. Stale Code ;I15mIStr lata <br />LL 16. Slate Arca Ollme <br />17. OSM Field 1B. OSM Area 19. OSM <br />Ollice No. Ollice No. Sample No. <br />m 0 ~ 20. Type o11r.sVecnor 21. Jo~nl Inspection <br />(Code) Ves No <br />l 22 Inspector's ID <br />No. <br /> ~~ i~ ~ <br /> <br />23. Status __ <br />24, Type C1 AClrvity (c'+eCk apphoo Dle COaesl. <br />A m Type of Permit <br />A ~ Steep Slope E _ <br />~~ Anthracite <br />B m Mlne Status (Cotle) <br /> <br />C Type of Facility (Code) <br />m <br />8 ~ Mountain fop Remo.al F _ <br />~ ~ F¢d_ral Lands <br />r'~~ C ^ Rime Farmlands G ~, Indian Lands <br />D LJ-_L_1-_L-LJJ Number of Permittnd Acres <br />~ <br />~ <br />D ^ Alluvial Valley Floors H <br />~ Other <br />~ Number of Disturbed Acres <br />E 1 1 1 1 1 1' I <br />25. Performance Standards (Codes! <br />Inalruellons: Intllcate compliance code. For any standard marked 2 or 3 provide narralrve In support tn~s dererminatmn. <br />Standards Thal Limit the Ellects to the Permd Area Standards That Assu•e Recram aYion Ou9lily antl Ti meliness <br />A ~ Dlslance Hrohibilions M ~ Topsoil Handl~nd <br />B ~ Mining Within Permit Bountlaries N ~ Back!iil u•g ar~o GraOing <br />C ^ Signs and Markers O L Following Reclamation SohecL de <br />D ^ Sediment Control Measures P ^ Reveyelalinn Requ~remerits <br />E ~ Design and Ceridlcation Requirements- O ~ Disposal of Excess Spoil <br />Setllment Control <br /> <br />F ~ Effluent Limlis <br />R ~ Handling of Acid or Toxic Materials <br /> <br />G ~ Surface Water Monitoring S ^ Highwall Elimination <br /> <br />T ~ Downslope Spoil Disposal <br />H ~ Ground Water Monitoring <br /> <br />I ~ Blasting Procedures U ~ Post Mining Land Use <br /> <br />J ~ Haul/Access Roatl Design and Maintenance V ~ Cessation of Operations: Temporary <br /> <br />K ~ Rafuse Impountlmenis WOther _ _ _ _______ <br />y ________ <br />L ~ Other: Specify _ ~_, ~ .,__,.... - <br />Distribuliom Original -Field Ollice, Green ~ Headquarters, Blue ~ State's Copy. Yellow Inspector s CoDY~ Pints ~ File Gopy IE ~ 1fi3 (1(831 <br />