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Monument Dam <br />Inspection Form <br />Date: /0/ l X I <br />Time: 2 QP-, <br />Name of Inspector: C * <br />Current Panel Being Mined: KC- <br />❑ Weekly Inspection .Monthly Inspection <br />I-a(,Q Q 45E�� rj 01 <br />Yes No <br />❑ A Is mining within 1 mile of Monument Dam? <br />❑ Are there visible surface cracks on the darn':` <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 />dam (perform visual inspection and data analysis of inclinometers)? <br />If yes, describe, <br />Notes: (I , <br />"�( <br />(7bo :34 7 <br />Signature of Inspector: S �� <br />Inspections are performed under the #ection of Michael J. Peacock, P. E. <br />-If cracks or other potentially damaging features occur, notify Robin Schiro or Wendell <br />Koontz immediately. <br />