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November 5, 2012C-1981-022/Elk Creek MineSLB <br />AVS Annual Review <br />Inspection Worksheet <br />Date <br />October 30, 2012 <br />Mine Name/Permit Number <br />Elk Creek Mine C-1981-022 <br />Inspector Signature <br />Based on your ON-SITE Observation, please answer the following: <br />1)Mine ID sign <br />a)Permittee <br />Oxbow Mining, LLC <br />b)Operator <br />Oxbow Mining, LLC <br />c)MSHA ID (not required to be on sign) <br />05-04674 <br />2)Direct inquiry (of persons on the site) <br />a)Permittee <br />Oxbow Mining, LLC <br />b)Operator <br />Oxbow Mining, LLC <br />c)MSHA ID <br />05-04674 <br />3)Is ownership/control information for permittee and operator noted in field consistent with what <br />is listed in the permit application? Yes No _______ <br />X <br />If No, what is in conflict? <br />_____________NA__________________________________________________________________ <br />__________________________________________________________________________________ <br />_________________________________________________________________________ <br />Number of PartialInspection this Fiscal Year: 5 <br />Number of CompleteInspections this Fiscal Year: 1 <br />55 <br />Page of <br />