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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 1b 1c <br /> Mine Site Evaluation Inspection Report M M <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 /> L jr-� �—' -1 1-1 � (,� <br /> 3.Street Address 11.State Permit Number <br /> 4.City 5. State 12 Name of Mine <br /> �Tlr 14� 4d� <br /> 6.Zip Code 7�rea Code 8.Telephone Number 1.CCo2ty Code 14. State Code 15. 16.State Area Office <br /> - -,�—�, I 1-� E,]�) <br /> i Ell <br /> [� <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 <br /> No No. <br /> 23.Status 24.Type of Activity(c`)eck applicable Doxes) <br /> A � Type of Permit <br /> A E Steep Slope E Anthracite <br /> B Mine Status(Code) <br /> B u Mountain Top Removal F Federal Lands <br /> C �' U Type of Facility(Code) <br /> C � Prime Farmlands G E] Indian Lands <br /> D f J • U Number of Permitted Acres <br /> D Alluvial Valley Floors H Other <br /> E L (� j • L 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 Assu•e Reclamation Duality and Timeliness <br /> A Distance Prohibitions M r--,—T—.psoil Handling <br /> B Mining Within Permit Boundaries N Backfilling and Grading <br /> C FTI Signs and Markers O '� Following Reclarnabon Schedule <br /> D 2 Sediment Control Measures P Revegetation Requirements <br /> E © Design and Certification Requirements— O F Disposal of Excess Spoil <br /> Sediment Control <br /> R Handling of Acid or Toxic Materials <br /> F Q Effluent Limits <br /> S F1 Highwall Elimination <br /> G '� Surface Water Monitoring <br /> T ❑( Downslope Spoil Disposal <br /> H a Ground Water Monitoring <br /> `� U © Post Mining Land Use <br /> 1 � Blasting Procedures !Y� (- '•�,;.. �y�� <br /> ti V Cessation of Operations:Temporary <br /> J M Haul/Access Road Design and Maintenance <br /> K � Refuse Impoundments W 0 Other <br /> Jv r' t'`-'�.{-^u-�-- <br /> L Other. Specify r', <br /> Distribution: Original-Field Office, Green-Headquarters, Blue-State's Copy,Yellow- Inspector's Copy. Pink-File Copy IE- 163(1/83) <br />