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v ~ ._ i:~u~ is JVi. <br />/ate JcJ JJCG r. Cb <br />Indications of potential failure or Instability: <br />N'o u,'stK, (C~v,~r~+~ c ~ o~ t~+Slor track s, ~Yr-, wys o~..setrJ <br />Threat to human life or property: <br />~%/~~r a~(oo e ~P.sons <br />a'~ er~~'p+ti~ 4d~oc~7` ~ P <br /> <br />Potential harm to land, air, and waterlresources; <br />Maintenance Required: <br />~'~( .sl~o~l~ ~. <br />4+~v~ c~MpQC~I, <br />p~~sS~rO ~ (';Pt's qn~ 4,ir'~On'Y,~/ mrn;Xe~e~~ <br />Supporting Documentation (Compaction tests, surveys, photographs, other measurements): <br />Inspector <br />~/~,~~5 <br />pate <br />Send to: Colorado Division of Minerals & Geology within 2 weeKs of quarterly inspection <br />(4.09.1(11}(b)). <br />'See 4.0911(c) for additional requirements. <br />+_v .,,. oa i ;n Page 2 of <br />