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~ ®~~1~~ Illplll I IIIIIIIII III <br />4~-~~~~~ r ~ ®~~ <br />~~~~~ <br />•- - - ~ - DEC 1419 6 <br />. United States Department of the In terior for Office Use Only <br />- Office of Surface Mining MINED L.P. 'D <br /> <br />. Mine Site Evaluation Inspection Re~BCLAMATION <br />IVI ,c ,p <br />m m <br />' Y Y M M Baicn Repon <br />-~ ~ - ~ ~ <br />Z. Name of Permittee ~ <br />9. MSMA Number ~ 10. Date OI Ins DECbpn <br />(Y Y M M D D) <br /> 1' 1 <br /> 3. Street Adtlreea ~ ~ 11. $Iale Permit Number <br /> <br />8 <br />~ <br />o <br />v <br />G <br />8 <br />'} <br />- <br />0 <br />6 <br />~ -- ~ <br />I i~ <br />a. Clly ~ ~ 5. ate ~Z~ t2. Name o <br />M~ne <br /> <br />- <br />® ~ <br />~ <br />~ Irt lei f~3 <br />8. Zlp Code - 7. Area Cotle - BB. <br />TeleDnone Numoer~. 17. County Cotle tt. Stare Coee <br />Srr <br />t S. <br />ata 6. <br />tate Aroa Ollice <br />t <br />S <br />~ ITJ <br />II <br />l I~ <br />~ <br />I <br />77: OSM Fleltl ~ 18. OSM Area 1g. OSM <br />~ 20. Type of Inspection 21. Joins rnspection 22 Inspector's ID <br />Office No. ~_ Olflce No. ~ Sample No. . ~ (Cotle) ~ {Y~e~s no ND. <br /> <br />23. Statue ~ ~ ~- ~ ~ ~ <br />- - 2e. Type of Activity Icneck applicable coaes). <br />~ A ~ ~ Type of Permit <br />_ <br />- -- ® ~ `-~~ ~' ~ ~ ~ <br />~ <br />A -~ ~ Steep Slope <br />E ~ Anthraate <br />_ _ B -~ ~ ~ Mine Status Cotle) <br />®-~= ~ ~ - -'~ ~ ~ <br />~ , <br />B ~ Mountain ToP Removal <br />F ~/1 Fooeralirna• <br />~_ C_ ®. -~ <br />_ - Type of Faelllty (Cotle) ~ <br />- ~ <br />C a Primg Farmlantl5 ~1 ~qL <br />G ~ Intlian LentlS <br />- D /~• Number of Permdtetl Acres <br />" <br />'-` <br />~T <br />~~~"" ~ <br />D. ~ Alluvial Valley Floors <br />H Other <br />E `++.- „~'..r-'i--`~' Number of Dlsturoeo Acres <br />~ <br />~ <br />~ <br />25. Perlwmance S:antlards (Codes: <br />IprgruGleaa: Intllcate compliance Cotle. For any s[andartl marked 2 or 3 prov~tle narratrve to suDpon Inis tlerrrminatnn. <br />r <br />s That Limit the EHecls to the Parmil Area <br />Stantl <br />a <br />tl S[antlartl5 Thal Assu'e Reciam align Ou.aliry antl Timelineps <br />t n <br />- <br />- <br />~ <br />I Distance hohlDitions ~ - <br />A r-J <br />I M <br />W Topsoil Hantllmg <br />w <br />-. <br />Mining Within Permit BOUntlaries <br />' B ~- ~ <br />N <br />l , I Back!illu~q ano Gratling <br />i <br />~ <br />C <br />~ Signs and Markers O <br />ii j1- <br />Following Reclamation SU~edale <br />~ <br />~ <br />r <br />D 1 f 1 Sediment Control Measures P <br />nt <br />Reveyetat~on Requirements <br />E 4 Design antl Cartillcation Requirements- Disposal of Eacess Spoil <br />O. <br />Y-' Sediment Conroe ~ <br /> <br />F Q Effluent LImIIS R Hantlling of Acid or Toxic Materials <br />I~ <br /> <br />G Surface Water Monitoring 5 I ' 1 Hrghwall Ellminalion <br />~-F~ <br /> T <br />Downslope Spgil DISD05al <br />H Grountl Water Monitoring ~ <br /> <br />I ~ Blasting Procedures U Post Mining Lantl Use <br /> V n Cessation of Operations: Temporary <br />L~J <br />J ~ HaullACCess RoaO Design and Maintenance <br />~~4ii---"' W ~ Otner <br />K Refuse Impoundments <br />L Other: SDecily <br />Distnoution; Original - Fieltl O11 ¢e, Green ~ Heatlquaners, Blue -Stele's Copy, Yellow ~ Inspector's Copy. Pin4. Fde CoDV IE ~ t63 ItiH31 <br />