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• ~ iiiiiiiiiiuiiuiii <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />DeVartment of Natural Resources <br />1717 Sherman Si., Raom 215 <br />Dcnver, Cobrarlo 80203 <br />rnnnr•: anll 866.3667 AVS Annual Review <br />F\X:13071832-8106 p Inspection Worksheet <br />Date . O <br />Mine Name/Permit Number Q c p,~ ~rf! e <br />Inspector Signature <br />Based on your on-site observation, please answer the following: <br />1) Mine ID sign J /~ <br />a) Permittee Grgn~ yo ~(C= CA, <br />b) Operator I T_~j,~ Ud. ~~~ ~~~, <br />C ~ro-ao~ <br />c) MSHA ID Qs 0 ~ t913 (not required to be on sign) <br />2) Direct inquiry (of persons on the site) ~+ <br />a) Permittee `r/+4I7~ /Vti~l//Y, //~/C~, <br />b) Operator ~/`¢hr~f U4 ll ~ y (.-~~~ ~ - <br />c) MSHA ID 5 O~~ ~ I' 3 <br />~~ <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Grnemor <br />dames 5. Lochhead <br />E>tecwive Dheaor <br />Michael B. Long <br />Division Director <br />3) Is ownership/control information for permitee and operator noted in field consistent with <br />what is -isted in the permit application? Yes No // <br />If No, what is in conflict? f/ ~ ~ <br />~J9,~,.u~ /i?~.v:.r~~.~r /l/o. ~ l0 u~he~cclrne~/-!' l~l ~,n~~e~x.~`/1'/g <br />e <br /> <br />DMG is required to verify this information as specified in [he AVS MOU if the p~initting action was <br />approved subsequentlyto the MOU (renewal, transfers snd revisions). Annualy as long as coal extraction <br />from [he site has not been completed, DMG must determine whether officer/controller information is <br />complete and accurate in AVS. In makingthe detertninationofcomple[eand accuratenformation, on-site <br />observations and direct inquiry of persons on [he site is necessary. The information on this form will be <br />verified with AML, MSHA, and EIA information in AVS. Please return the form to Erica Crosby to be <br />verified in the AVS. <br />c:\esclavs\an n ual <br />cv <br />