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Monument Dam <br />Inspection Form <br />Date: - <br />Time: 4 <br />Name of Inspector: <br />Current Panel Being Mined: Jr) �c(3 Y . <br />2 Inspection ❑ Monthly Inspection <br />Yes No <br />❑ Is mining within 1 mile of Monument Dam? <br />❑ ❑ Are there visible surface cracks on the dam? <br />If yes, indicate length and size of crack. <br />Notes: <br />Is there evidence of subsided areas on or around dam? <br />If yes, indicate where and degree. <br />Are there bulges on the dam? <br />If yes, indicate where and degree. <br />Are there signs of seeps on the dam? <br />If yes, indicate where and estimated flow. <br />❑ ❑� Are there any other potentially damaging features on the dam? <br />If yes, describe. <br />Are there any recent evidences of slope failure on the landside south of the <br />dam (perform visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Signature of Inspector: _ / <br />Inspections are perfbrine /under the direction of Michael. J. Peacock, P.E. <br />-If cracks or other potentially damaging features occur, notify Robin Schiro or Wendell <br />Koontz immediately. <br />