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r <br />Date: C) i /J 1/ <br />Time: <br />Name of Inspector: <br />Current Panel Being Mined: <Th <br />❑ Weekly Inspection)Monthly Inspection <br />Yes No <br />❑ Is mining within 1 mile of Monument Dam? <br />O 0 Are there visible surface cracks on the dam? <br />If yes, indicate length and size of crack. _ r <br />❑ ❑ Is there evidence of subsided areas on or around dam? <br />If yes, indicate where and degree. _ 1 1 t <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. r• , <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: <br />Signature of Inspector: <br />Inspections are performed under th <br />Monument Dam <br />Inspection Form <br />N <br />,A <br />rection of Michael J. Peacock, P.E. <br />-If cracks or other potentially damaging features occur, notify Robin Schiro or Wendell <br />Koontz immediately. <br />