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_F <br />In/d~ications of potential failure or instability: /,. ,~-~/~ <br />/v D (~NiR'PHGr° O ~ ~/IS,Ov~ G /'rrC c~S ~ G ~ '^ W 4f <br />Therreat to human lifeAor pro~p}e^rty: <br />lzrr~Uf~° ~l~U P (7~C~ <br />to ~; l~ o c ass, 6lY <br />Pe~s~s o~ PToP~~xy <br />s,~~ ,~% ~y ia. - <br />Potential harm to land, air, and water resources: <br />e se~v~~ <br /> <br />Maintenance Required: <br />1, ~,'p, 41~~~y ~'D/ c©~ifbcf /'227~°~;~ ~ r.~~ere so <br />Q2°4 S cr ~ o,DS~rv>°~ gA <br />a ~i°~~ du ]~ Cu ll/L°I'~ ~ ~v~ib~Sh ~5,75~!/P o«q.~no~ <br />Supporting Documentation (Compactiontests,snrveys, photographs, othermeasurements): <br />Inspector <br />~ /~/ <br />Date <br />Send to: Colorado Division of Minerals & 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 />;" . ,~ <br />