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Monument Dam <br />Inspection Form <br />Date: L,21.>20111 <br />Time: /0 <br />Name of Inspector:S Cif �c�V G rhUQ <br />Current Panel Being Mined: E, XC - S 7 . <br />❑ Weekly Inspection Monthly Inspection <br />Yes No <br />❑ Is mining within 1 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 />L n 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 />F J Are there any other potentially damaging features on the dam? <br />If yes, describe. <br />i ri 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 />' � AcrvL K)6 T L t 61.x. <br />Signature of Inspector _. <br />Inspections are performed <br />-If cracks or other poterhiail <br />Koontz immediately. <br />ler the direction of Michael J. Peacock, P.E. <br />damaging features occur, notify Robin Schiro or Wendell <br />