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RECEIVED <br />AN 1 6 2009 <br />Division or Keciamation, <br />Monument Dam Mining and Safety <br />Inspection Form <br />Date: C ZC)O 6 <br />Time: <br />Name of Inspector: -c <br />Current Panel Being Mined: <br />Yes No <br />? K Is mining within 1 mile of Monument Dam? <br />? 9 <br />? 9 <br />? 9 <br />Are there visible surface cracks? <br />If yes, indicate length and size of crack. <br />Is there evidence of subsided areas on or around dam? <br />If yes, indicate where and degree. <br />Are there any other potentially damaging features on the dam? <br />If yes, describe. <br />9 ? Are there any evidences of slope failure on the landside south of dam? p <br />If yes, describe. i?u wt,e rc?: G? c?Gs ?,t F,e<. G("- s(71" Sees a Fs(? ae. <br />Notes <br />Z7 zoos <br />Signature of Inspector: <br />-If cracks or other potentially damaging features occur, CDRMS, the Minnesota <br />Reservoir Company, SEO, USFS and other appropriate agencies will be notified by MCC <br />immediately. <br />•