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w gat[ III I II I II ~ II IIII III <br />R~~FivFn Paps,ol2Pepw <br />United States Department of the InteriorA~ ~ 0 ~ 198 For Oftlce Use Only <br />Office of Surface Mining <br /> <br />Mine Site Evaluation Inspection ~~~pND RECLAMATION <br />COb. Dept of Natural Re , <br />DIVI <br />urc ,b ,a <br /> <br />m m <br /> Y Y M M Bakh Report <br /> TD. Dafe of Inspection <br />2. Name o1 Parmlttee 9. MSHA Number (Y Y M M D D <br /> ~ ~ - I - ~ 7 ' <br />3. Street Adtlrass 11. Stets Parmlt Number <br /> I <br /> 4. City 5. State t2. Name of Mine <br /> <br /> t , .. ® ~ le R. ! <br />8. Z~~l/gyp C~~io~d7e~~~~~~~ ~7. A~r~es~'Cotle S. Telephone Number <br />I~L_l~J LI~J 13. County Code 14. State Code i5. Strata <br />® m m 16. State Aree Office <br />/T. OSM Field 18. OSM Area 7g. OSM 20. TyDS of Inspection 21. Joint Inspection 22. Inspectors ID <br />a~ o. 0~11(ce No. SamDl~ fCatl~ ~ ® N® <br />23. Stelua 24. Type o! Activity (check appllcaDle hazes). <br />A ®/ Type of Permit <br />A ~ Steep Slops <br />E ~ Anthrattte <br />B ® Mlne Statue (Code) <br />B ~ Mountain Top Removal <br />F ~ Federal Cantle <br />C ~ Type of Feclllly (COtle) <br />C ~ Prime Farmlantla <br />G ~ Indian Lentla <br />D ~ Number of Permlttetl Acre9 <br />D ~ Alluvial Valley Floors <br />H ~ Other <br />E ~ NumDer of Disturbed Acre9 <br />25. Pertormance Stentlards (COtlea) <br />Mtnuu9ana' Indicate compliance code. Fa any atantlard marketl 2 or 3 Drovitls nanatlve to support /DIS determinatlort. <br />Stentlards Thet Limit the Eflects to the Parmlt Area Standartla Thet Assure Reclamation Ouallty and Timeliness <br />A ~ Distance Prohlbltlona M ~ 7opaall Handling <br />8 ~ Mlnlnp Within Parmlt Bountlarlss N ~ Backlllling entl Gratling <br />C ~ Slons entl Markare O ~ Following Reclamation Schedule <br />D ~ Satllment Control Measures P ~ Revepetatlon Repulremente <br />E a Design entl Cenllleatlon Repulremente- O ~ Disposal of Excess SDOII <br />Setllmsnt Control <br />R ~ Nantlling of Acltl or Toxic Materiels <br />F ©EHluent Llmlts <br /> <br />G ~ Surtece Walsr Monltoring S ®Nlghwall Ellminatbn <br /> T ~ Downslope Spoil Dlaposel <br />H ~ Ground Water Monltoring U ~ Post Mlning Lantl Use <br />I ~ Blasting Procedures <br /> <br />J ~ HaullAeeees Road Dealgn end Maintenance V ~ Caseation of Operations: Temporary <br /> <br />K ~ Refuse Impoundments W ~ Other <br />L ~ Other. Specify <br />DlaIrIDUfIOn: Original • Field Office, Green - HeaOQuaners, Blue - Stete'a Copy, Yellow ~ Inspector's Copy, Pink - Flle Copy IE - 183 (1183) <br />