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<br />Indicazions of potential failure or ins[abiliry. <br />/~•~- Ala ~l d P~. <br />'Ihreaz to hutttan life or property. <br />v~ / ~~~~. -h~ `acv-~ , ~-~ ~-+~/-- ~~ ~`4-`~°- ~aph,~~ a~-p~-y~ <br />/r'~}L(i(~ (,~1 2C~LCl~~Yi'~-v~-rt...d`'2r~`~~1yrs d~ o/ ~XoffLC~-mil (O <br />(,_L VGA- ~, %!s fem./ `9! ~ ., !/ <br />Potential h to land, air, and wazer resources. <br />vii eke ~ ho-~-e/eu-a~~ ~ ~.-~-t.~ c~~~i ~/~~~a~~~i~~~ <br />~~ ~ , <br />M//a~~inteppnance Required//. /~ / // <br />/~- /-u s-~- ~ [ lc_ QSu r f~-~-- /1 ~S l~vr ~~l~ecf' ~ Cor-. 5 ~'u ~~d,-, <br />• <br />Supporting Documentation (Compaction/tests, surveys, Photographs, other man~.z..+..,«). <br />``~ <br />. ~ `~~ <br />Ltspeaor Supecquing P.E:'= ` - _ <br />~~ ~~ ~~AS ~Y T~ T' <br />Date ?~-, <br />Send to: Colorado Division of Minerals 8c Geology within 2 weeks of quarterly inspection (4.09.1(11)(b)). <br />• See 4.0911(c) for additional requirements. • <br />Page 2 of 2 <br />