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V "FIVED Page 1 of 2 Pages <br /> United States Department of the Interior NOV 989 For Office Use Only <br /> Office of Surface Mining MINED L IIND,a 1b 1c <br /> Mine Site Evaluation Inspection Rep(RECLAMAT!ON DIV S O M M <br /> Y Y M M Batch Report <br /> 10 Date of Inspection <br /> 2. Name of Permittee 9 MSHA Number (Y Y M M D D) <br /> 3.Street Address 11. State Permit Number _ <br /> 4.City 5.State 12 Name of Mine <br /> I � I-TiTT�T1 M UF-r- <br /> i I T=11 =LILLI <br /> 6.Zip Code 7.Area Code 8.Telephone Number 13.County Code 14. State Code 155 Strata 16. State Area Office <br /> !LJ 11 <br /> 17.OSM Field 18.OSM Area 19.OSM 20 Type of Inspectior 21 Joint Inspection 22 Inspectors ID <br /> Office No. Office No. Sample No. (Code) Yes No No <br /> 23.Status 24.Type of Activity(check applicable coxes) <br /> A m Type of Permit <br /> A DSteep Slope E � � Anthracite <br /> mMine Status(Code) <br /> B LI Mountain fop Removal F i_ Federal Lands <br /> C m Type of Facility(Code) <br /> C [� Prime Farmlands G (—l Indian Lands <br /> D • Number of Permitted Acres L J <br /> D El AlluvialValley Floors H � Other <br /> E • Number of Disturbed Acres <br /> 25 Performance Standards (Codes) <br /> Instructions: Indicate compliance code For any standard marked 2 or 3 provide narrative to support this determination <br /> Standards That Limit the Effects to the Permit Area Standards That Assu•e Reclamation Ouality and Timeliness <br /> A Distance Prohibitions M Topsoil Handling <br /> B Mining Within Permit Boundaries N Back+i!Imq and Grading <br /> C Signs and Markers O Following Reclarriat,on Schedule <br /> D ❑ Sediment Control Measures P L� Revegetation Requirements <br /> E Design and Certification Requirements— O ❑ Disposal of Excess Spoil <br /> Sediment Control <br /> R Handling of Acid or Toxic Materials <br /> F F—] Effluent Limits <br /> S Highwall Elimination <br /> G � Surface Water Monitoring <br /> T Downslope Spoil Disposal <br /> H � Ground Water Monitoring <br /> U Post Mining Land Use <br /> I � Blasting Procedures <br /> V Cessation of Operations Temporary <br /> J Haul/Access Road Design and Maintenance <br /> W � Other <br /> K Refuse Impoundments <br /> L Other: Specify <br /> Distribution: Original- Field Office, Green - Headquarters, Blue-State's Copy, Yellow - Inspector's Copy Pink - File Copy I - 163(1/83) <br />