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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 la 1b 1c <br /> Mine Site Evaluation Inspection Report Ffl 0 <br /> Y Y M M Batch Report <br /> 10 Date of Inspection <br /> 2. Name of Permittee 9 MSHA Number (Y Y M M D D) <br /> 3. Street Address 11 Stale Permit Numer <br /> 614 C, �-�1 I �LI, <br /> I TM-F, <br /> 4.City 5. State 12 Name of Mine <br /> r o Tp�1\ ; -- / ; <br /> 6.Zip Code 7. Area Code 8.Telephone Number _ 13. County Code 14 State Code 15 Strata 16.State Aiea Office <br /> 0 0 <br /> 17. OSM Field 18 OSM Area 19 OSM 20 Type of Inspection 21 Joint Inspection 22 Inspector's ID <br /> Office No. Office No. Sample No. (Code) Yes No No, <br /> E� 0 D l o d—LL11 0 R- <br /> 23. Status 24.Type of Activity(c`ieck applicable poxes). <br /> A ® Type of Permit <br /> A ��(, Steep Slope E � Anthracite <br /> B KEI Mine Status(Code) <br /> r-�--t B Mountain Top Rertioval F .(,�� Federal Lands <br /> C p I Type of Facility(Code) f'�l <br /> A'`�' 3 0 C Prime Farmlands G Indian Lands <br /> D • Number of Permitted Acres <br /> D � Alluvial Valley Floors H Other <br /> E O �?� • Number of Disturbed Acres u <br /> 25 Performance Standards(Codes! <br /> h►structionx Indicate compliance code For any standard marked 2 or 3 provide narrahve to support this determination- <br /> Standards That Limit the Effects to the Permit Area Standards That Assure Reclamation Quality and Timeliness <br /> A © Distance Prohibitions M Topsoil Handling <br /> B 51 Mining Within Permit Boundaries N Back+illmg and Grading <br /> C If] Signsand Markers O Following Reclamation Schedule <br /> D [j] Sediment Control Measures P R veyelation Requirements Ll <br /> E © Design and Certification Requirements— O Disposal of Excess Spoil <br /> Sediment Control <br /> - _ ' R Handling of Acid or Toxic Materials <br /> F F Effluent Llmlts �p �"}'�Iti T I^r-S+`lT� !� <br /> oy` 5 ��1__ S I ' I HighwallElimination <br /> G n Surface Water Monitoring G•� <br /> r-4-' T n Downslope Spoil Disposal <br /> H Firl Ground Water Monitoring two <br /> n U I � I Post Mining Land Use <br /> I a Blasting Procedures iw�,fpy� � �� 4--i <br /> d V Cessation of Operations Temporary <br /> J © Haul/Access Road Design and Maintenance El <br /> W 0 Other _ <br /> K � Refuse Impoundments O /(( M%',p0 <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 />