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Indict[ion:;. of po[ential failure or ins[ability. <br />~, <br />n • <br />f7/oy~ J ~/Js~'d'rJet%1'. <br />Threaz to human lift or property. /~ <br />(/~ f~~~e._y; hdci Pv-~n1 /,c/i~cCw~ C~~uQ.~ lm~l/~~ ~PrSSNS ~Pyc~~7~'~ <br />! N ~-- cZ P ec.~ a n~C `~ c~ ~~~(~4 - ~OP ~OYT ~JJ ~frw/c / ~^~ <br />Potcntial harm to land, atr, and water resou/rces. p p / <br />~~ ~! ~`~ Gj o cv P~ ~a ~ Lam- Ciwr~x it~/~ci [~ ~ra tulu~ S ~=i,6~c7~~j <br />~~~ J at' I ./~ oc <br />~o CI.a-~ /4'ttd ~ ~i2~ ~~ /~u/ga~Ud~~ /'(/Cl~~ <br />Maintenance. Requited. <br /> <br />n <br />Supporting Documentation (Compaction tests, surveys, photographs, other tn.ee,,..,nn,ra). <br /> <br /> F <br />9 <br />~ /' ~ro <br />~ ;=te <br />~ <br />ovr a <br />Inspec <br />or Supc'tviaiis$ P.E. : ~ - <br />t <br />Datd t <br />Send to: Colorado Division of Minerals & Geology within 2 weeks of quarterly inspection (4.09.1(11)(b)). <br />• See 4.0911(c) for additional requ'rremmts. . <br />Page 2 of 2 <br />