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_- _ - <br />_ - _s ~._ ~:::. United States Department of the Interior_`_~:~.-:. <br />- • °•'~. `-`'~ ' --•- :? :Office of Surface Minin <br />- ~-- - __- ' " -.. Mine Site Evaluation Inspection.. Report,=~ ~~•~ :.' _~- - <br />' 2. Neme al Permlltee ~ ~- <br /> <br /> f ~ A <br />J. SIIeeI Address ~- - I ~~ ~ ~ - <br /> _ ~ _ - <br /> _ ~ _ I J <br />.aa <br />. <br />CItY -~ S State <br />/ <br />~• <br />I_ <br />` 1. ~ . f' ., '.~ .. <br />rs <br />e <br />7 <br />. <br />A <br />o <br />de ,_ ~ B. Teleonone Number <br />B. 21p Cooe <br />O <br /> ~ <br />~ <br />~ ~- <br />~[ <br />]} " <br />~~ <br />+.' ~ <br /> <br /> <br />n.e.. a : l.p.. <br />} _ -- - - <br />y .-' .. For Office Use Only <br />- u ~ .. - _ 7D ~ lc <br />~.. m <br />' T Y M M ~ 9•ten fi••on <br />' _ <br />9 MSNA Number - - __ _ 10. Dale OI InSDICIIOn i <br />- ~ N y M M D Df ; <br /> J: <br />71. Slate Permd Number - <br />. ... <br />~ ~ ~ '' ' <br /> ° ~~ . <br />12. Hams of Mme ~-' <br />~ <br />yt <br />1'~. <br />' <br />1 22 <br />~L-~I fI II <br />~ 1 I II 1 <br />I I <br />I ! I <br />i 1 <br />17. County Code u. Slate Cooe 75. Duals 16. Stele Aroa Olhc! <br />-: a : ~ ~ <br />77. OSM Field ~. ~ 16. OSM Arat _~ 79. OSM .. <br />~ 20. Type of tnsoaction 21. Joint Inspection - 22. Inspector's ID <br />~ OHice No. - ~ <br />.. <br /> <br />:. <br /> <br />... <br />ONlce No. ~ ~ - Sample No. <br />•~ ~ ~ <br /> <br /> <br />~ <br />~ <br />~ <br />~r ICooel ~ ~ - Yes No ~ _ No. <br /> / y <br />~~/ ~1r ~ <br />~ ~~ <br />J ~ <br />2J. Status •~ - - _ - <br />._ <br />~ . - _. __.- <br />.r_:. .'•~ <br />Y <br />3_ <br />A . 'TYPe of PermR~G`-; ' _~z ;:- <br /> - <br />J <br />- -~ 8 ~I~ - _ - '_ _ <br />' <br />' ~ Mine Status (Code1 <br />- <br />-~. :.._ r ._! <br />,~ <br />, <br />- - -' C. r . •-. <br />. <br />.. l _ <br />~' ~ <br />TYDe of FecII1tY (Code) ~~ <br />~~ <br /> y . <br />. <br />'- ~:._ D ~ ~ ~~~, ~ ~T• Number of Permitted Acres. ~-- <br />E~ 0I~ • I Number~ol Dliturped Acres <br />2~. Type OI Actrviq (peck apOhcDDie coxed. <br />' <br />_ <br />~ <br />- _ ~ <br />i . .. .. <br />A ~IeeD SIODe ,: ~ ~'~ r: ,: E~'~ ~AnlnraCite <br />: ~~~B~ ~ ~MOUmainrTOp Rertiwel ~ ~ F n FMeml Lanc- <br />i C~~~„~ Prime Farmlands <br />~~_ ~~- ~ ~ G ~ Indian Lancs <br />`= D_: 'l~ - <br />Alluvial Valley Floors .-- ~ H {~l . Otner ' <br /> <br />s `.: .': -' : ~; .:~ ",~.:= ::.., : - ~. '~__ -. . rmance Standards lCodesl, ~. - - _- ---- <br />~~ In•rruetbnt Indlcal! COmplianpe COOe. For any slanOafd marke0 2 pr 3 prpvioe ndRabve'tn SuDDOrt this tlelPrmmatmn. .. <br />Sta ndards That Llmlt the Ellects to the Permit Area' ~'-' ~ ~ 'Standards Tnat Assu•e Reclamation Oualily and TimelineDS .~:. <br />~A ~ Distance ProhlDitions' _._, - - .. ~ - - ~ M n'TOPSOiI Handling - .-• ~' <br />LJ <br />Lw <br />. -' B D Minrnp Wlthtn Permit BOUntliries ' <br />_ - N ' ~ <br />Back!iihr,q and Gradlnq ~ ~ ~ .~ ~ ~ - <br />_ C ~ - <br />SiOns and Markers . ~ - ~ ~ ~ 0 L Pollowmq Reclartal~on Sched~ae <br />D a Sediment Control Measures ~ ~~ ~ -•~ ~ P ~ Reveuetation Reouirements ~• <br />- E a Design end GenNlcation Repuirements- ~ O ~ Disposal of Excess Spoil ~ - ...- <br />.~ - <br />' ~ Sedtment Control <br />~ <br />R <br />~ Nandlinp of Acid or Tonic Materials <br />_ F- ~ Ellluent Llmlts <br /> 5 ~ Mignwall Ehmmallon <br />- G ~ Surtaee water Monttorlnq <br />- T r~ Downslooe Spoil Disposal <br />H ~ Ground Water Monitoring <br />U ' <br />~ Post Mmmq Land Use <br />1 ~ Blasting Prxeduraa <br /> V ~ ~ Cessation dl Operations. Temporary <br />J ~ HaullACCess Road Dasipn and Maintenance <br /> W ~ Otner <br />... K ~ Refuse Impoundments G~±.~ i /', 01" <br /> <br />L <br />~ w ~.1~~~ <br />Otner SDecily <br /> <br />Distribution: Original - Fettl Olhce, Green ~ Headouaners. Blue ~ Stare s Copv. YeHOw ~ lnspeupr's Copy. Pmk -File CoDY IE ~ t6J Iv?: <br />