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<br /> <br /> <br />~II II~~I~II~~~~~ ~I~ <br />sss <br />-6=' <br /> <br /> <br />Pape 1 0l 2 Papea <br /> ~r <br />~ • ~ <br />` <br />United States Department of the In ~ <br />~~ <br />teri r y' <br />For Office use Only <br />Office of Surface Minj~ <br />Mine Site Evaluation Inspectiopport ~ <br />~ <br />P 13 1 <br />91~ <br />~~ <br /> }} <br />p~ <br />IVlinad L nd .y Y M M ealcn Repon <br /> ~~ ivision <br /> 10. Date of Inspection <br />2. Name W Permittee ~ - 9. MA Number (Y Y M M D D) <br /> I' ; r,' -~ g u a G t v a - o o o - Y ! G k' <br /> 3. Street AOdress 11. State Permit Number <br /> - PJ J X I G G S o ' O ~ <br />4. Ci[y 5. Stale e <br />ol M <br />in <br />e <br />t2. Na <br /> <br />~' <br />4 <br />K <br />C <br />£ <br />C- <br />~ <br />K <br />G v ':;~ I <br />~ ~~ <br />Tl <br />Y" ~ <br />l~ I~ <br />IT <br />N+ I I i IrT <br />I I T <br />I I ~; <br />I I~ <br />~ I~If~IiT1I <br />I I I 1-I <br />6. Zip Code 7. Area Code 8: Tel phone Number <br />8 46 S U~ 7 -3 1 ! I 13. County Cotle 14. State Code 15. Shah <br />Q co ~ <br />~ 16. Stale Area Otlica <br />~o/ <br /> . <br />17. OSM Fleld 18. OSM Area 19. OSM 20. ~~YYppaA; Irspecuon 21. Joint Inspection 22 Inspector's ID <br />Ofl~ o. O <br />Illce No. Sampl~ (~F__ Yes No <br />I <br />~ <br />~_ <br />l I <br />11 II <br />I I <br />~ NOS <br />1 <br />I II <br />~ I <br />5 c <br />L <br />IC <br />X~I <br />1 <br />L J <br />J Z <br />y 51 <br />23. Status - 24. type e! Activity (check applicable coxes). <br />A m Type of Permit <br />=~ <br />A L Sleep Slope <br />E ~ Anthracde <br />B ® Mine Status (Cotle) ' <br />B ~ Mounlaln Top Rertwval <br />F ~ Federal Lands <br />C Type of Facility (Code) <br />C ~ Prime Farmlands r7 <br />G LJ Indian Lantls <br />J <br />~~~~ <br />D u-+~~---L., Number of Permitted Acres D ~ Alluvial Valley Floors H ~ Other <br />E (. r9 • Yl Number of Disturbed Acres <br />25. Performance Standards ICodesl <br />Inttruetbn•: Indicate compliance code. For any Standard marked 2 or 3 provitle narrative to support this tleterminauon. <br />Standards Thal Limit the Effects to the Permit Area Slandartls That Assure Reclamatlor. Oualily and Timeliness <br />A ~ Distance F•rohiDitions M ~ Topsoil Handling <br />B ~ Mining Wlthln Permit Boundaries N ~ Back!ill~ng aritl Grading <br />C ~ Signs and Marken O ~ Fo6owing Reclamafwn Schedule <br />D ~ Sediment Control Measures P ~ Revegetatina Requirements <br />E ~ Design and Cenlllcation Requirements- O ~ DisDOSaI of Excess Spoil <br />Setlimenl Control <br />R ~ Handling of Acid or Toxic Materials <br />F ~ Eflluent Llmlts <br />S ~ Highwall Elimination <br />G ~ Surlace Water Monitoring <br />T ~ Downslope Spoil Disposal <br />H ~ Ground Water Monitoring <br />U ~ Post Mining Land Use <br />I ~ Blasting Procedures <br />V ~ Cessation of Operations: Temporary <br />tl Desi <br />H <br />llA <br />R <br />d M <br />t <br />gn an <br />enance <br />J ~ <br />CCese <br />oa <br />ain <br />au <br />W ~ Other ____ ___ <br />K ~ Reluse Impoundments <br />L ~ Other: Specify ~ _ <br />Distribution: Original ~ Field Ollice, Green - Heatlquarters, Blue ~ Sl ale's CoDY. Yellow ~ Inspector's GODY~ Pink ~ File Copy ~ IE - 163 (7163) <br />