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d <br />Indications of potential failure or instability: <br />ND ev~olPr1C~ mT y"+-°-'IS7~O~'1 Gr'OC~'S~ t°7~. G/OS O.6SPl'c~q/. <br />Threat to human life or property: <br />~4~ ~u re G Du~p~ G~°C~ Pe~.5O~1.5 ~ ~ P~perx y Qs~~4fe°r~ y` <br />7a p-~~. <br />Potential harm to land, air, and water resources: <br />~~~i~~c COu~o~ 4Y-~f~ct ~ie Prsgy-of~~ I~if~l~/; <br />Maintenance Required: <br />~er ~'o~n.l Pao ~o~~ .~,~~2~~ qs oP; recY~~ P~~~; ovs/r,. <br />Supporting Documentation (Compaction tests, surveys, photographs, othermeasurements): <br />Inspector <br />/~~ f ~ <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 />Jab No. 28,170 Page 2 of 2 <br />