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~~ <br />`\ <br />Pape Z of 2 Pages <br />" United States Department of the Interior <br />Office of Surface dining <br />Mine Site Evaluation Iti9pbotion Report <br />ffi State PienMt Number ~ 27. Date of Inspection <br /> (YYMMDD) <br />_ - - '+ ~ :' <br />?ll. Yee No Do miMng and reclamation activities on the site with the plans in thepermit? <br />•O ~ If no, de nartative to su ort this determinatio ' <br />28. Irdkats nunrbw of complete and partial inspections conducted by the State to date for this annual review period: <br />29a. m Number of Completes 29b. ®Number of Partials -~ <br />30. Indicate nunber of complete and partial Inspections.iequired by the State during this annual review period: <br />30a. m Number of Completes 30b. ,~ Jfumber of Partials <br />37. Has Iropar.'Ifon lnquerw,y been met? <br />Yas No YAS No <br />31a. ^ ^ Compbtee 31b. _ - p Partials <br />32 FEDERAL ENr-0R(~MENT INFORMATION. [Enter violation i. Check appropriate box(es)[ <br />Ten-0ay Notice No. -f Notice of Wotation No. ~ ssation Order No. Violation Codes <br />A ^ ^ Authorizations to Operate <br />R ^ ..................... ^ .................... . ^ ........................ Signs end Markers <br />C ^ ..................... ^ :...:............... .:.................... <br />. ^ :. Backlillinp snd Gredlnp <br />D ^ _.--...._.-. •._...... ^ .................... . <br />. Hiphwall Elimination <br />E ^ ................... <br />^ ....................... <br />~ ^ Rills and Gullies <br />.. <br />.................... <br />F ^ ..................... ^ . <br />. <br />^ Improper Fills <br />G Topsoil Handling ' <br />H ^ ..................... ^ .................... . ^ ........................ Sediment Ponds <br />1 ^ .. ............. <br />.... <br />. <br />... <br />^ .......... <br />. <br />..... <br />^ Effluent Limits <br />. <br />.. <br />..... <br />... <br />........ <br />J ^ ^ .... <br />.. <br />.. <br />. <br />~~ ~ . . ............ • ..... , ... Water Monitoring <br />K ^ ^ ^ ........................ Buf7er Zones <br />~~, -~=t/ <br />LL`7 17:.'::~.-.~~`t.-.{.... ^ .................... <br /> <br />........................ <br />. ^ <br />Roads <br />............. <br />M ^ -• ................... ^ ...... . ^ ........................ Dams <br />. <br />N ^ ....... .............. ^ ^ Blasting <br />O^ ~ ^ ,~ ~ Revegetation <br />P ~ ^ ^ • . . .. . ... . . . ..... . .... . . SPoil on the Downslope <br />O ^ ..................... ^ .................... . ^.......................... Mining Without Permit <br />R ^ .....---•--.......... ^ .................... . ^ ...-.................... Exceeding Permit Limits <br />S ^ ^ ^ ........................ Distance Prohibitions <br />T ^ ^ ^ Toxic Materials <br />. ~ ~ - ~ +, ~ ~ - . , . ........................ Other Violations <br /> <br />33. Name of AuBror_ized Representative (print or type) <br /> <br />Signature of Auttgrimd Representative Date ~' - <br />_~ ~ `~~ ~~ l/• i ..r 1 ~ ~ ~~ <br />Signature ileviewirrg OHicia~--~ <br />~ Date <br />` ~ r; n <br /> , ~, <br />5 <br /> c~ ~ <br /> <br />DbtrlDutfon Original - FIe1C Ofrlce, Green - HeadQuaners, Blue -Slab's Copy. Ysllow • Inspector's Cgpy, Plnk ~ Plf9~glIIT 1E - 763 (1185) <br />