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Page 1 of 2 Pages <br /> United States Department of the Interior For Office Use Only <br /> Office of Surface Mining 1a I 1c <br /> Mine Site Evaluation Inspection Report Ul IT] I]] <br /> Y Y M M Batch Report <br /> 10. Date of Inspection <br /> 2. Name of Permittee 9 MSHA Number M <br /> (Y Y M M D D) <br /> 3.Street Address 11 State Permit Number _ <br /> = ! t - <br /> 4.City 5 State 12 Name of Mine _ <br /> �TFJT M LET I =a=L[EL11 <br /> 6.Zip Code 7.Area Code 8.Telephone Number �13. County Code 14�State Cooe 15Strata 16 State.Area Office <br /> L-1-1 J j 1 ILE [ ] <br /> 17.OSM Field 18. OSM Area 19.OSM 20 Type of Inspectior 21 Joint Inspection 22 Inspector's ID <br /> Office No. Office No. Sample No. (Code) Yes No No. <br /> [11 LI-LL-1-1 ]IP =111 <br /> 23. Status 24. Type of Activity(check applicable boxes) <br /> A m Type of Permit _ <br /> A � Steep Slope E i Anthracite <br /> B W Mine Status(Code) �— <br /> B LI Mountain Fop Removal F Federal Lands <br /> C m Type of Facility(Code) <br /> C [� Prime Farmlands G � 1 Indian Lands <br /> D • Number of Permitted Acres J <br /> D Alluvial Valley Floors H Other <br /> E • Number of Disturbed Acres J <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 Assure Reclamation, Ouality and Timeliness <br /> A ❑ Distance Prohibitions M LJ Topsoil Handling <br /> B Mining Within Permit Boundaries N Backti!linq and Grading <br /> C Signs and Markers O Following Reclarnat-on Schedule <br /> D Sediment Control Measures P Revegetation Requirements <br /> E ❑ Design and Certification Requirements— Q ❑ Disposal of Excess Spoil <br /> Sediment Control <br /> R Handling of Acid or Toxic Materials <br /> F F-1 Effluent Limits <br /> S Highwall Elimination <br /> G F-1 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(1183) <br />