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Mining Area <br />Date Inspected <br />Impoundment <br />C"I c 0 A IT <br />17 <br />Are there any appearances of erosion, instability, structural weakness or other <br />hazardous conditions? NO <br />If yes explain: <br />Are there any existing and required monitoring procedures and instruments? PO <br />If yes explain: <br />The depth and elevation of any impounded waters at the time of inspection. <br />Existing storage <br />spillway).- <br />of water in the impoundment (from principal <br />Required storage c ity of water in the impoundment (from principal <br />spillway). - M <br />Any other aspects of the structure affecting stability, or requiring <br />maintenance. NC) tj & <br />Has structure been maintained as designed and in accordance with the approved plan <br />and the applicable regulations? $t e <br />1 <br />If no explain <br />\\0 R <br />M <br />--3 <br />17274 <br />VA - <br />0 N A L <br />PR OFTSSI ONA L EN GINETR 'S S TA TEMEN T <br />/ state that thl's pond was 1??spected <br />and surveyed under my supervIsion <br />and GH the Information presented <br />hereon is true and correct to the <br />best of m)l knowledge and <br />/?7 forn-? a llon. <br />I&Lt-4 <br />Dale CurtIs V. Belden, CO /O.E. 17,274