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Monument Dam _ <br />Inspection Form <br />1 <br />Date: ////I/// <br />Time: <br />Name of Inspector: <br />Current Panel Being Mined: <br />❑ Weekly Inspection r. Monthly Inspection <br />Yes No <br />❑ Ef Is mining within 1 mile of Monument Dam? <br />❑ 1� 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 />❑ 1� Are there bulges on the dam? <br />If yes. indicate where and degree. <br />o [if Are there signs of seeps on the dam? <br />If yes, indicate where and estimated flow. <br />ff 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 />dam (perform visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Notes: I <br />IiC i� It t dVf r <br />Signature of inspector: l <br />.Inspections are performed 7yn r the direction of Michael J. Peacock, P.E. <br />-If cracks or other potentially damaging features occur, notify Robin Schiro or Wendell <br />Koontz immediately. <br />