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Monument Dam <br />Inspection Form <br />Date: 1 / 13 /l Q <br />Time: <br />Name of Inspector: tZ- S <br />Current Panel Being Mined: 5--d- XC 35 <br />❑ Weekly Inspection CpqMonthly Inspection <br />Yes No <br />❑ [X Is mining within I mile of Monument Dam? <br />❑ ❑ Are there visible surface cracks on the dam? <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 bulges on the dam? <br />If yes, indicate where and degree. <br />❑ ❑ Are there signs of seeps on the dam? <br />If yes, indicate where and estimated flow. <br />❑ ❑ Are there any other potentially damaging features on the dam? <br />If yes, describe. <br />❑ Are there any recent evidences of slope failure on the landside south of the <br />am (perform visual inspection and data analysis of inclinometers)? <br />f yes, describe. <br />Notes: <br />I /0 5 Noy✓ /M v <br />Signature of Inspector: <br />Inspections are performed un er the dir ctio e J. Peacock, P.E. <br />-If cracks or other potentially damaging features occur, notify Ryan Sweetwood or <br />Wendell Koontz immediately. <br />