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-TI VA <br /> � a <br /> Page 1 of 2 Pages <br /> United States Department of the Interior 9� For Office Use Only <br /> Office of Surface Mining Sf? ?, S 19 la lb 1c <br /> Mine Site Evaluation Inspection Report ned ®1 S`0 1]] <br /> IDMi fan <br /> VjeC1aM60r' Y Y M M Batch Report <br /> 10. Date of Inspection <br /> 2. Name of Permittee 9 MSHA Number IIr (Y Y M M D D) <br /> I Ll 1-11= <br /> L T <br /> 3.Street Address 11 State Permit Number C <br /> �U <br /> LLi L� i L� <br /> I <br /> 4 City 5.State 12 Name of Mine j <br /> [T T I I I E LL'11 <br /> 6.Zip Code 7.Area Code 8.Telephone Number �13. County Code 14�State Code 15 Strata 16.State Area Office <br /> L_L_1_J E �_J <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 /> ni - <br /> 23.Status 24 Type of Activity(check applicable boxes) <br /> A m Type of Permit <br /> A D Steep Slope E � Anthracite <br /> B m Mine Status(Code) <br /> B Mountain rop Removal F Fpderal Lands <br /> C m Type of Facility(Code) <br /> C [� Prime Farmlands G [j Indian Lands <br /> D • Number of Permitted Acres <br /> D � Alluvial Valley Floors H <br /> E • Number of Disturbed Acres L_] Other <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 Reclamat;on Quality and Timeliness <br /> A Distance Prohibitions M LiTopsoil Handling <br /> B Mining Within Permit Boundaries N Back!i!hnq and Grading <br /> C Signs and Markers O � Following Reclamat-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-] 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(1/83) <br />