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I <br />'~_ <br />I <br />7.' r? <br />- t~l _~_ ~~~~ ~II II~II~~I~~~~~ ~I~ <br /> ~. <br />999 ~ <br />~~. - '. Y <br />-` ~ <br />...-._. <br />- --h v <br />_ _ <.r,-r' tes~De~artnYent'of` <br />~ .. .. _~ <br />--. FoROffice Use~Ohly~s~- _-. , <br />- <br />-.=~ ~ - tic~ok3u~fac~Mtnln ._ N <br />_ '~> ".!--~ <br />EVafuatroirs inspectiorr'H'epart~: <br />-- _ <br />. - . : MI`necSl ^ <br />~.~ ._ <br />_ try- •' _ "=-_-_ <br />,a ~ fic- r.- <br />' <br />r'~I <br />~-1 <br />1 <br />.~G <br />. - -4 {Zt i'~i. .~ S~ _ _ _11c .. S• :_ <br />~ . _ <br />_` ~ I <br />I'~ <br />III <br />II <br />m <br /> <br />.___ -.~~ ; - ~.T_L'C.S- _ A <br />._~ ~. .., _. <br />1~ ~ <br />:. _ - <br /> <br />.. y Y M 111 <br />~ <br />ePUn <br />- /gyp Cp <br />ch <br /> .IQ ~-1 J.J <br />Li <br />~- -~ ~ ~ - ~ ~ ~ ~ 10. Date of Inspection <br />2. Nema of PermlttlreE ~ - - ~ ~ •- 0.• MSHA Numbsc - - ~ ' - ~ _ (Y Y M M D D) <br /> <br />3. Street Atldrses- 11. State Permit Number <br /> 1 - <br /> i <br />4. City 5. State 12. Name of Mine <br /> <br /> r ~ r I ~ ~ r. 1 <br />8. ZIp tls -~Q7. A~~r`e~aI~/C~~a~de 8. Telephone Number <br />L_L1J - - 13. County Code 11. State Code 15. Strata <br />~ ~ m 1B. State Area Olflce~ <br />J <br />17. OSM Field: 18. OSM Area 19. OSM 20. Type of Inspection 21. Joint Inspection 22. Inspector's ID <br />OHics No. OMlce No. Semple No. (Codsl Yee No No. <br />t3. Status 2<. Type of Activity (check applicable boxes). <br />A ~ Type o} Permit <br />A Sleep Slope <br />A <br />th <br />it <br />E <br />r-~---r <br />B I I I Mlna Statue (Code) <br />~-1.~. <br /> <br />8 ~ Mountain Top Removal n <br />rac <br />e <br />~ <br />F ~ Federal Lands <br />C ~ TYDB of Facility (Code) <br />~ <br />s <br />~ <br />C ~ Prime Farmlands r <br />G ~ Intllan Lands <br />-~,._- <br />- <br />,-- <br />~ <br />D I `Y `I 'I ~I I e I I Number of Permitted Acres <br />t-J--~--I--fly- <br />l <br />D ~ Alluvial Valley Floors <br />H ~ Other <br />, <br />. <br />E I' I ' I `f ~ 1 e I I Number of Disturbed Acres <br />~~__I__L1~~ <br />25. Pertormance Standards (Codes) <br />Inehuctlonc Indicate compliance coda. For any standartl marked 2 or 3 provide narrative to support this Oeterminallon. <br />Standartle That Limit the Effects to the Permit Area Standards That Assure Reclamation Oueliry and Timelinasa <br />A ~ Dlatsnce Prohlbitlana M ~ Topsoil Handling <br />8 ~ Mlnlnp Wlihln Permit Bountlarlea N ~ Backfllllnq end Gradlnq <br />C ~ Slgne and Markers O ~ Following Reclamation Schedule <br />D ~ Sediment Control Measures P © Ravagetatlon Requirements <br />E ®Deelgn antl Certlflcatlon Requirements- O ~ Dlaposel of Excess Spoil <br />Sediment Control <br />R ~ Handling of Acld or Toxic Materials <br />F ~ EHlusm Llmlts <br />S ~ Mlphwall Ellminetlon <br />G ~ Surtace Water Monitorlnq <br />T ©DownsloDe Spcll Dlaposel <br />H ®Graund Water Monitorlnq <br /> U ~® Post Mlnlnq Lantl Use <br />I ® Blasting Procedures <br />V ~ Caseation of Operations: Temporary <br />J ~ HaWACesas Road Design end Melntenance <br />W ~ Other <br />K '~ Refuse Impoundments ~ .r <br />Att. r.L i--/t.: ~:...~i J ~3 /'/.` ~ _ <br /> <br />~, <br />_ ', vt :1 <br />y <br />L ~ Other. Specify _c~i'c, ' <br />,~.rt ..~1~~0_ r~~ + :'IEG/'C ~-'-K :. <br />J <br /> <br />Dlatrlbutlan: Original -Field OHlce, Green - Headquarters Blue • State's Copy, Yellow - Inspector's Copy. Plnk~- Flle Copt IE - 18317183) <br />