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RECF-i"J eo <br /> Pape 1 of 2 Paps <br /> li <br /> United States Department of the Interior MIN ED o-AN� <br /> of Surface Mining' .� „ . REC;LAMATI N DIVI �ffice Use Only- <br /> Office <br /> to tb' 1c <br /> Mine Site Evaluation Inspection.Report .. <br /> - - FF M- m <br /> z 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.State Permit Number <br /> 4.City 5.State 12 Name of Mine <br /> 6.Zip Code 7.Area Code 8.Telephone Number 13.County Code 14. State Code 15�Strata E <br /> 16State Area Office <br /> � k 7a '�F UE aj - - LT <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 /> � - ak0 - �Q1 <br /> 23.Status - 24.Type of Activity(check applicable coxes). <br /> A Type of Permit <br /> - A �[�"Steep Slope E Anthracite <br /> B � Mine Status(Code) � <br /> B Mountain Top Removal F Federal Lands <br /> C �� - Type of Facility(Code) <br /> C Prime Farmlands G Indian Lands <br /> D ? •FC7 Number of Permitted Acres <br /> — _ D � Alluvial Valley Floors H Other <br /> E ? • Number of Disturbed Acres <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 Ihrohlbitions M I ,'Topsoil Handling <br /> B Mining Within Permit Boundaries N Backfilhng and Grading <br /> C Signs and Markers O E-11 Following Reclarriat-on Schedule <br /> D/� Sediment Control Measures P Revegetation Requirements <br /> E Design and Certification Requirements— a- Disposal of Excess Spoil <br /> Sediment Control <br /> R Handling of Acid or Toxic Materials <br /> F Effluent Limits <br /> S Highwall Elimination <br /> G F� 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 F-1 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 />