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Date: /U . ;�L- / 2 -- <br />Time: / ,/, 1 7pry <br />Name of Inspector: - Jo (c7 <br />Current Panel Being Mined: z. 3, <br />XWeekly Inspection ❑ Monthly Inspection <br />Yes No <br />❑ Are there visible surface cracks on the dam? <br />If _yes, indicate length and size of crack_ <br />❑' Is there evidence of subsided areas on or around dam? <br />If yes, indicate where and degree. <br />❑ Are there signs of seeps on the dam? <br />If yes, indicate \\\°here and estimated tloY, . <br />Notes: <br />/tl2,G "1_v H lc t� <br />- J -- z) 61 u � r2 � � c' C <br />Signature of Inspector: <br />Inspections are perfornLcl 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 />Are there bulges on the dam? <br />If yes, indicate where and degree. <br />❑ Is mining within 1 mile of Monument Dam? <br />Monument Dam <br />Inspection Form <br />Are there any other potentially damaging features on the darn? <br />If yes, describe. <br />Are there any recent evidences of slope failure on the landside south of the <br />dam (perfoini visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />es <br />