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Date: (._. °c • <br />Time: if - )- "'" <br />Name of Inspector: • <br />Current Panel Being Mined: <br />Weekly Inspection ❑ Monthly Inspection <br />Yes No <br />C o Is training within 1 mile of Monument Dam? <br />Monument Dam <br />Inspection Form <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 bulges on the dam? <br />If yes, indicate where and degree. <br />Ci q Are there signs of seeps on the darn? <br />If yes, indicate where and estimated flow. <br />n G7 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 (perfolnh visual inspection and data analysis of inclinometers)? <br />If yes, describe. <br />Notes: () t (2:4 �' L 3 -' , ® <br />Signature of Inspector: _ (t� r' — <br />Inspections are perfornied 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 />