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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 - 8106 <br />Date ,23 Orr . ?w2 <br />AVS Annual Review <br />Inspection Worksheet <br />Mine Name/Permit Number Nc a p :x,: ,•` fir, ,R - C- /9 aJ 091-5 <br />Inspector Signature %��t�p,�h �, •!! <br />Based on your ON -SITE Observation, please answer the following: <br />1) Mine ID sign <br />a) Permittee W£ST6P/V <br />b) Operator %ftM <br />c) MSHA ID (not required to be on sign) <br />2) Direct inquiry (of persons on the site) <br />a) Permittee WE 5Ti174 v ) -, (O1--of L �r <br />b) Operator S fl Mc• <br />c) MSHA <br />Office of <br />Mined Land Reclamation <br />If No, what is in conflict? <br />STATE OF COLORADO <br />3) Is ownership /control information for permittee and 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 />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />