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-- _ J Peg. t or 2 Peoee <br />United States Department of the Interiolvli~ed Land. <br />"Office of Surface Mining mation Divi, <br />Mine Site Evaluation Inspection R~~~ <br />For Office"Use-Only <br />as ~ 16 m <br />~. ~ m <br />Y V M M 8etdn AeP•rt_ <br />10. Date of lnapecti <br />2 Nema o! Permltlee <br /> <br />"3 Sheet ~Addrees ~ ~ ~ " <br /> .' _ _ ~_ <br />~4. G 5. State <br />r ~ ~ <br />. S. Zfl Code <br />~J 7. Area lode <br />~ e. Tale one Number <br />- - - - <br />3 <br />12. Name bf Mlne <br />19. County Coda to Slata Coda IS. Strata Id State Aroa~GfRee <br />m <br />17. OSM FIeM 1B. OSM Area 19. OSM 26. Type ol.Inapectlbn 27;.Jo1nt Inspeetron 22 Mapeators tD <br />Oryke No. ~ e No. Sample Na _ ,C°de ~. Na .. - N <br />~7,3~I{Stelj`mB ~ ~~iT 1~f ]~ 24. Type a/ Actlvlty (check apj~pl~IJajabfe Eoxesj. .. <br />_ _ A -~ Typa of Permll p, rT EtceP Slope <br />@ m tehre Status (Code) Ll <br />S ~ Nountaln top Remora! <br />C . Type of Faclllty (Code) <br />C ~ Prlme Farmlands <br />0 ., i C ~ • ., Number of Pormllted Ames ~ ' <br />] D ~ Allurlel Va11eY Flows <br />E .l ~; „ -.• p • :^' I Nnmber of Dlaturbetl /facts <br />E ~ Amhraotte <br />F ~-.'~ .Fralerffi.laetla <br />G C~ rndlan rands <br />N ~ Omer <br /> 25. PerfoRrlellCe $tarMarQ6 !Codes) <br />_ ~ Irnhugfmre hldlCele Compllence code. For any atenderd~marketl 2 or 3 Drovlde nerratlva In support mis determinatlon. <br />Sianderde That LImK the Effects ro tha Permlt Area StenderUs Thel Asawe Rectamellon Quality and Timelmaa9 <br />_ __ A~-~DlatangeJ~rohlbRlana _ <br />, ~ M ~'Tapaoll HandlMg <br />~ Mlning Wlmin P•rmll Boundaries <br />- 9~ ' N ~ Sack!Iihnq and Gratling <br />C ~ Signs and Merkere- . t G <br />, ~ Fdlowing Reclamation Sctiedule <br />D ~ Sadlment Control Meaavrea ~~ -• P ~~ AeveBetatbn Requlremanla ~ - <br />E , ~ Daelgn end CertRkAROn ReQUiremgnta- ~ V ~ Dlspo9el~df Excesa Spoil . <br />Sediment Control <br />R <br />~ Nandling of Acidpr Toxic Materiels <br />F ~ Ettleent Llmlts <br />S <br />~ Mghwall Ellminatlon <br />O ~ SuAace Water Monltorlnp <br /> T Q Downslope SPOiI Disposal <br />N ~ Ground Water Monltoring ~ ~ <br />U .. ~ _ _ _ _ _ <br />~ Pool Min!np Lend Use <br />I ~ 8lesling Proc•dUres <br />fJ~~h <br />(, C~L~ <br />~ <br />a Cessetlon of OPerallona: Temporary <br />. <br />.. J ~ ©NeugAeeeee Road Design and~Malntenence <br />i r~ ir,,,~y?r <br />~ W <br />~ Other <br />K i~ Refuse Impoundments <br />' <br />' <br />?T/. <br />ah.r. sveelry <br />L <br />J^- <br />~Dlatrlbutlon: Orlplnal • FIe10 Olllca, Green ~ Hoadquartera, Blue ~ Stale'a Copy, Tallow ~ Inspector's CoDY• Pink ~ File Copy ~ ~~ IE • 1a3 !1IBJ1~ <br />