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For The Folly„ing Entries, Circle The appropriata Choice: t = 1nSpeC Led dnd toursd In compliance, NA _ Inspection Topic not applica~le, N = Nit Inspected, R =Inspected and Comments no tad, V =Inspectea ana Violations (v0'J) or Cessation Order (COl issues, B = Inspected and both Comments noted 8 Violations or Cessation Grder issued, T = 10 Day Notice Issued by OSM Oversight Personnel, S =Sample taken and sent to the lab from analysis - describe type and location of sample taken under comment section, GENERAL INSPECTION TOPICS: CORDS........... ~_ Y / NA / N / R / V / B / T / S ] LC] SIGNS AND MARKERS ................. l Y / NA / N / / V / B / T / S ] LCJ ROADS ............................. L Y / NA / N /UR / V / B / T / S J LCJ HYDROLOGIC BALANCE ................ L Y / NA / N / R / V /U / T / S ] LCJ BACKFILL 8 GRADING ................ L Y / NA / N / ®/ V / B / T / S ] LC] EXPLOSIVES ........................ L Y~/ NA / N / R / V / 8 / T / S j L~:J PROCESSING WASTES ................. L Y / ~i7g / N / R / V / B / T / $ j LCJ SUPPORT FACILITIES ................ L U / NA / N / R / V / B / T / S ] LCJ TOPSOIL ........................... ! Y / NA / N / R / V /~/ T / S J LCJ GENERAL MINE PLAN COMPLIANCE...... L Y / NA / N /~/ V / B / T / S J LCJ FISH 8 WILDLIFE ................... L Y / NA / N /OR / V / B / T / 5 ] LCJ REVEGETATION ...................... L ~ / NA / N / R / Y / B / T / 5 ] LC1 AIR RESOURCE PROTECTION........... ! S / NA / N / R / V / B / T / S ] LCJ SLIDES 8 DAMAGE ................... l Y / NA / N / ~/ V / B / T / S ] LCJ SUBSIDENCE ........................ L Y / I~A / N / R / V / B / T / S ] LCJ EXCESS SPOIL 8 DEYELOPMENT WASTE,. L Y / NA / N /~/ Y / 8 / T / 5 ] LCJ OFFSITE SUPPDA7 FACILITIES........ L Y / ©A / N / R / V / B / T / S ] LCJ RECLAMATION SUCCESS ............... L ~Y / NA / N / R / V / B / T / S ] LCJ SPECIAL CATEGORIES OF MINING...... ! Y / ® / N / R / 4 / B / T / S ] (1) L20 (21 -------------------- Spaces (3) -------------------- Max] - - - - - - - - - - - - - - - - - - - - L+:J OTHERS ............................ L Y/ NA / N/ R/ V/ B/ T] (1) ~~ N 0- S u? Y~y--------- Leo (2) Spaces (3) -------------------- MaxJ NOTE: LCJ Required Entry.