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❑ Is mining within I mile of Monument Dam? <br />❑ [ Are there visible surface cracks on the dam? <br />Monument Dam <br />Inspection Form <br />Date: to ( ILA (l0 <br />Time: 1. ( 2p <br />Name of Inspector: Q yam <br />Current Panel Being Mined: a- Xe_ Y <br />❑ Weekly Inspection � Monthly Inspection <br />Yes No <br />If yes, indicate length and size of crack. — <br />El <br />❑j <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 />❑ `9 Are there any recent evidences of slope failure on the landside south of the <br />dam (perform visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Notes: <br />Signature of Inspector: <br />Inspections are performed er the d r c o Michael J. Peacock, P.E. <br />-If cracks or other potentially damaging features occur, notify Ryan Sweetwood or <br />Wendell Koontz immediately. <br />