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Page 2 of 2 Pages <br /> � t <br /> United States Department of the Interior <br /> Office of Surface Mining <br /> Mine Site Evaluation Inspection Report <br /> 26. State Permit Number 27. Date of Inspection <br /> (YYMMDD) <br /> 28. Yes No Do mining and reclamation activities on the site comply with the plans in the permit? <br /> ❑ ❑ If no, provide narrative to support this determination. <br /> 29. Indicate number of complete and partial inspections conducted by the State to date for this annual review period: <br /> 29a. ❑ Number of Completes 29b. ❑ Number of Partials <br /> 30. Indicate number of complete and partial inspections required by the State during this annual review period: <br /> 30a. ❑ Number of Completes 30b. ❑ Number of Partials <br /> 31. Has inspection frequency been met? <br /> Yes No Yes No <br /> 31a. ❑ ❑ Completes 31b. ❑ ❑ Partials <br /> 32. FEDERAL ENFORCEMENT INFORMATION.[Enter violation number. Check appropriate box(es)] <br /> Ten-Day Notice No. Notice of Violation No. Cessation Order No. Violation Codes <br /> A❑ ❑ 1-1Authorizations to Operate <br /> ..................... ..................... <br /> B❑ ❑ ❑ Signs and Markers <br /> ..................... ..................... <br /> C❑ ❑ 1-1Backfilling and Grading <br /> ..................... ..................... <br /> D❑ ❑ 1-1Highwall Elimination <br /> ..................... ..................... <br /> E❑ ❑ ❑ Rills and Gullies <br /> ..................... ..................... <br /> F❑ ❑ ❑ Improper Fills <br /> ..................... ..................... <br /> G❑ ❑ ❑ Topsoil Handling <br /> ..................... ........................ <br /> H❑ ❑ 1-1Sediment Ponds <br /> ..................... ..................... <br /> I ❑ ❑ ❑ Effluent Limits <br /> ..................... ..................... <br /> J ❑ ❑ ❑ Water Monitoring <br /> ..................... ............... ...... <br /> K❑ ❑ ❑ Buffer Zones <br /> ..................... ..................... <br /> L ❑ .. ...... ............. ❑ ................,.... ❑ ............ .. .......... Roads <br /> M❑ ... . .. ............... ❑ ..................... ❑ ............ .. .. . .. .. ... Dams <br /> N ❑ ..................... ❑ ❑ Blasting <br /> ..................... .... .. .. ... . .. .......... <br /> O❑ ❑ ❑ Revegetation <br /> P❑ ❑ ❑ Spoil on the Downslope <br /> ..... ................ .................... . <br /> Q❑ ❑ ❑ Mining Without Permit <br /> ..................... ................ ..... <br /> R❑ ❑ ❑ Exceeding Permit Limits <br /> ..................... .......... ........... <br /> S ❑ ❑ ❑ Distance Prohibitions <br /> .. ................... ..................... <br /> T ❑ ❑ ❑ Toxic Materials <br /> .. ................... ..................... <br /> U ❑ ❑ ❑ Other Violations <br /> .. .. ................. ..................... <br /> 33. Name of Authorized Representative(print or type) <br /> Signature of Authorized Representative Date <br /> Signature of Reviewing Official Date <br /> Distribution: Original-Field Office,Green-Headquarters, Blue-State's Copy,Yellow-Inspector's Copy, Pink-File Copy IE-163(1/83) <br />