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.,,. T <br />Indications of po/t~ential failure or instability: / <br />NO Si5 rJ 5 9T /`7 4fS ~, ~v r >° O r ; n57`~?'~i (,~y ti/~°/~ <br />~I~ 5~1q(l Sc.r~CC S/u~/~ pPocs not 4/~'~ fo <br />h'i~L° ~ZbrSr.°rlte~ <br />Threat to human l/ifee or pr/o~p/e'rty~: <br />~nccr/'~ C.mu~v ¢7-7`~`L7 ~~r~ons of~~D~~~Y ~!L°qr P~~~. <br />Potential harm to land, air, and water resources: <br />l R;~ure Cou~/ Q~~~ y ~1~ ~ur~gfor~ ~c-~V~r , <br />Maintenance Required: <br />(. ICe~-rir s/"Iq`~ S~un'/~ 4t~vG 3i~v° ~ev~c~ 4so~~r','~ <br />i~ ~r15Pa4c~-iOV, oP4'~ !l~a~lps <br />Supporting Documentation (Compactiontests, surveys, photographs, othermeasurements): <br />T~~~~ .~ <br />Inspector <br />~~~~~ <br />Date <br />., <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 />