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__ <br />- ., _ . <br /> <br />x.` <br />~ ` - ~l_._~-J <br />~'~` Indications of potentlal failure or Instability: <br />r;~ ,,; a - / <br />,-1 5r ~3 ~ ~^;t~4/SS ~,iurG (.,sez n©f o6Sc'rvr~ ~hG S~rQl~s/a~rf <br />q~s~ ~~~ 7"t;i~ ~C'v+c~ ogees X107` 9P~~~r' ~ ~t4vt! c/~rS~°^+/ <br />Threat to human life or property: <br />r~c, re_ cou (~ Q~c t" P~rfo~s o~ ~~'Pe~y a~ ~cer~ ro <br />~~ ~;1~ <br />Potential harm to land, alr, and water resources: <br />Maintenance Required: <br />Supporting Documentation (Compactiontests,suweys, photographs, other measurements): <br />~a6fe ~ <br />Inspector <br />i~r~o~ <br />Date <br />Send to: Colorado Division of Minerals & Geology within 2 weeks of quarterly inspection <br />(4.09,1(1'1){b)). <br />'See 4.0911(c) for additional requirements. <br />Job No. 28,7,70 Page 2 of ~ <br />