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Page 2 of 2 Pages <br /> United States Department of the Interior <br /> Office of Surface Mining <br /> Mine Site Evaluation Inspection Report <br /> 2&State Permit Number 27. Date of Inspection <br /> (YYMMDD) <br /> 2& 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 /> Authorizations to Operate <br /> Signs and Markers <br /> C❑ ❑ ❑ Backfilling and Grading <br /> ..................... <br /> D❑ ❑ ❑ Highwall Elimination <br /> ..................... ......... ............... <br /> E❑ ❑ ❑ Rills and Gullies <br /> ................... .. ......... ... ............ <br /> F❑ ❑ ❑ Improper Fills <br /> ..................... ........................ <br /> G❑ ❑ ❑ Topsoil Handling <br /> H❑ ❑ ❑ Sediment Ponds <br /> Effluent Limits <br /> Water Monitoring <br /> Buffer Zones <br /> L❑ .. ❑ ..................... ❑ Roads <br /> Dams <br /> N❑ ..................... <br /> ❑ ❑ Blasting <br /> ..................... ............ .. .. ... ..... <br /> Reve etation <br /> Spoil on the Downslo e <br /> Mining Without Permit <br /> Exceeding Permit Limits <br /> Distance Prohibitions <br /> Toxic Materials <br /> Other Violations <br /> 33. Name of Authorized Representative(print or type) <br /> Signature of Authorized Representative Date <br /> Signature of Reviewing Official Date <br /> Distribution.Originai-Field Office,Green-Headquarters, Blue-State's Copy,Yellow- Inspector's Copy, Pink- File Copy I -163(1183) <br />