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Date /v //? 1/2 <br />AVS Annual Review <br />Inspection Worksheet <br />Mine Name/Permit Number e - o% C- (92 ( — DLS` <br />Inspector Signature <br />Based on your ON -S Obse i on, please answer the following: <br />1) Mine ID sign ,�J <br />a) Permittee 31( /'/0u,w ; h C 1 ,C �► c • <br />b) Operator <br />c) MSHA ID C' a3S'Q <br />2) Direct inquiry (of persons on the site <br />a) Permittee � l ? // iv) <br />If No, what is in conflict? <br />/ <br />(not required to be on sign) <br />b) Operator <br />c) MSHA ID 0 S 0 3S o <br />3) Is ownership /control information for permittee an,, operator noted in field consistent with <br />what is listed in the permit application? Yes No <br />DRMS is required to verify this information as specified in the AVS MOU if the permitting action was <br />approved subsequently to the MOU (renewal, transfers and revisions) Annually as long as coal <br />extraction from the site has not been completed, DRMS must determine whether officer /controller <br />information is complete and accurate in AVS. In making the determination of complete and accurate <br />information, on -site observations and direct inquiry of persons on the site is necessary. The information <br />on this form will be verified with AML, MSHA, and EIA information in AVS. Please return the form to <br />Mary Rodriguez to be verified in the AVS. <br />