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_~ ~ l•ed States Department of the Inte~ <br /> Office of Surface Mining <br />' Mine Site Evaluation Inspection Report <br /> <br />26. Stale Permit Number 27. Date of Inspection <br /> (YYMMDD) <br />C- O S- o/ ~ G ~ 3 / ~/ <br /> <br />2f1. Yes No Do mining and reclamation act ivities on the site comply with the plans in the permit? <br />'~,r ^ II no, provide narrative to su port this determination. <br />29. Indicate number or complete antl partial inspections conductetl by the State to date for this annual review periotl: <br />29a. ~ Number of Completes 29b. ~ Number of Partials <br />30. Indicate number of complete and partial inspections required by the State during this annual review periotl: <br />30a. ~ Number of Completes 30b. p® Number of Partials <br />31. Has Inspection frequency been met? <br />Yes No <br />31a ~ ^ Completes Yes No <br />31b. ~ ^ Partials <br />32 FEDERAL ENFORCEMENT INFORMATION. [Enter vlalation number. Check appropriate box(es)] <br />TerfDay Notice No. Notice of Violation No. Cessation Order No. Violation Codes <br />A ^ <br />..' .................. ^ <br />....... ^ Authorizations to ODerate <br />.............. ........................ <br /> <br />B ^ <br />^ <br />^ ........................ SI ns and Markers <br />0 <br />C ^ ..................... ^ ....... .............. ^ Backfilling and Grading <br />........................ <br />D^ ^ ^ Nighwall Elimination <br />E ^ ^ ^ Rills and Gullies <br />F ^ ^ ^ Improper Fills <br />G ^ ..................... ^ ^ Topsoil Handling <br />H ^ ............ ......... ^ ^ Sediment Ponds <br />1^ ..... ...... .......... ^ ^ Effluent Llmlts <br />J ^ ^ ^ .. . . ............ . ..... . . Water Monitoring <br />K ^ ^ ^ ........................ Butler Zones <br />L ^ ..................... ^ ....... .............. ^ ........................ Roads <br />M ^ ..................... ^ ....... .............. ^ ........................ Dams <br />N ^ ..................... ^ ^ Blasting <br />O ^ ^ ^ ........................ Revegetation <br />P ^ ^ ^ .. . . ... . .. . . . . . .. . ..... . SPOiI on the DownslOpe <br />O ^ .............. ....... ^ ^ Mining Without Permll <br />R ^ ..................... ^ ^ Exceeding Permit Llmlts <br />S ^ ^ ^ Distance Prohibitions <br />T ^ ^ ~ Toxic Materials <br />U ~ ^ ^ Other Violations <br />33 Name of Authorized R~ res ntative (print or type) 34. Administrative Information <br /> <br /> <br />Slpnatur 1 uthor' Representative <br />Date a p • Permit Review (Hours) <br />~ L 3 . ~_ ~` b p . Travet Time (Hours) <br />Sign ure of evier g licial Date c p ~ . Inspection Time (Hours) <br />yl, ~~ S ~~ d O / . D Report Writing Time (Hours) <br />UietriG.diun. Onpinal FeIG Ollice, Green - Meadquarlai5, Blue ~ Slale'S CcpY. Yellow ~ Inspeclor'S Copy, Pink File Copy IE ~ 16J (17&31 <br />