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Date: <br />Time: 1'' r (6 = C_ <br />Name of Inspector: / , t (r-,_, <br />Current Panel Being Mined: <br />,t Weekly Inspection ❑ Monthly Inspection <br />Yes No <br />,(5' ❑ 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 />❑ Is there evidence of subsided areas on or around dam? <br />If yes, indicate where and degree. <br />Notes: <br />Monument Dam <br />Inspection Form <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 />f <br />Signature of Inspector: �_. ,; ;. L <br />Inspections are performed nder 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 />