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f <br />Indications of potential failure or instability: <br />No Pv1cp~Pv~G~ o ~ ter~S,~oh C/'~c~s~ ~~ wes <br />Threat to human life or pro//pyyerty: <br />{~;lurk Cfxt(c~ ~7`yec-t Pe~~°sts ~~ Pr°P~~~Y <br />~-o ~%l~ o ~ fbss,dly Si`rt~ f~; ~Y /a. - <br />Potential harm to land, air, and water resources: <br />e ~ve~ <br />q~~4C~n <br />Maintenance Required: / /? <br />l~ Il,'pi 4~~oP/'yr yrl~ GuwifbC7'~ MQ~~~~ ~ wker~ So T`-~ <br />42~°4S 4IL° oJS,e~v>°~ <br />~l L°Gv+ CJu 7`' Cu lvL°r7`' ~ ~v~ib~S~i ~bSi~i(/~ ol~Q~~n4~ <br />Supporting Documentation (Compactiontests, surveys, photographs, othermeasurements): <br />,9L' <br />~,.. ,\ <br />r~ <.:~ ~ 1 <br />~; i. - <br />.Gf~ ~~_. <br />co< .:i -Y <br />Inspector Sup ising P. E. ~~y\~lALCj ~ -/ <br />~~ 0 <br />Date <br />Send to: Colorado Division of Minerals 8 Geology within 2 weeks of quarterly inspection <br />(4.09.1(11)(b)). <br />'See 4.0911(c) for additional requirements. <br />Job No. 28,170 Page 2 of 2 <br />