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I� Page 1 of 2 Pages <br /> United States Department of the Interior For Office Use Only <br /> Office of Surface Mining la 1b 1c <br /> Mine Site Evaluation Inspection Report ITM IT M <br /> Y Y M M Batch Report <br /> 10. Date of Inspection <br /> 2 Name of Permittee 9 MSHA Number (Y Y MMMM DD D) <br /> LLLI <br /> 3. Street Address 11 Stat- Permit Number <br /> 4. City 5 State 12 NamP of Mine _ <br /> TE1_1 <br /> I 1ILL <br /> M I M, 1-TT 1711' L -L <br /> 6.Zip Code 7. Area Code 8.Telephone Number 13 County Code 14 State Coue 15 Strata 16 State Aiea Office <br /> d tj FT E <br /> -H [i <br /> 17. OSM Field 18. OSM Area 19 OSM 20 Type of Inspection 21 Joint Inspection 22 Inspectors ID <br /> Office No. Office No. Sample No (Code) Yes No No <br /> E n_ _LI, I LE, L-] Ll-�, <br /> 23. Status 24 1;oe of Activity(check applicable boxes) <br /> A m Type of Permit _ <br /> A _I Steep Slope E 1 Anthracite <br /> L— <br /> B W Mine Status(Code) `J <br /> B Mountain lop Removal F Faderal Lands <br /> C m Type of Facility(Code) _ <br /> C [ ] Prune Farmlands G �J Indian Lands <br /> D • ] Number of Permitted Acres J <br /> 1 <br /> D Alluvia! Valley Floors H L Other <br /> E Fj Number of Disturbed Acres <br /> 25 Performance Standard: (Codes) <br /> Instructions: Indicate compliance code For any standard marked 2 of 3 provide narrative to support this determination <br /> Standards That Limit the Effects to the Permit Area Standards That Assure Reclamation Ouality and Timeliness <br /> A1-1 <br /> Distance Prohibitions M Topsoil Handhnq <br /> L_J <br /> B Mining Within Permit Boundaries N Backfillinq and Grading <br /> C Signs and Markers O L J Following Reclaniabon Schediae <br /> D Sediment Control Measures P Reveyetation Requirements <br /> E Design and Certification Requirements— O L—J Disposal of Excess Spoil <br /> Sediment Control <br /> R E C LF <br /> R Handling of Acid or Toxic Materials <br /> F � Effluent Limits <br /> S Highwall Elimination to!AY 11 1988 <br /> G � Surface Water Monitoring C3 <br /> T � Downslope Spoil Disposal <br /> H Ground Water Monitoring MINED LA IN <br /> 1 Blasting Procedures <br /> U Post Mining Land Use RECLAMATION DIVISION <br /> � <br /> V Cessation of Operations Temporary <br /> J ❑ HaullAccess Road Design and Maintenance <br /> W � Other <br /> K Refuse Impoundments <br /> L E 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 />