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-._,. <br />_. , <br />l~ ~ <br />n. nrn,~ri~ <br />iIIIIII II11 11111111 <br />•ps o apes ' <br />United States Department. of the interior ~ <br />yIAY For Office Use Only <br />3'1992 <br /> <br />Mine Site Evaluatiori:Inapection Rep <br />grt : .Mine 1a <br />La 1b lc <br />m <br /> ' Reclamati n.D Y ' <br /> M Repor( <br />Batch <br />~' ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ <br />2. Name'of Permi(tee. ~ ~ ~ ~ '=7 ~ ~~ ~~ ~~~ ~' '~ ~~ ... . , --- ~ <br />9.~MSHA Number ~ ~' ~ ~10. Dale of Inspection <br />. (Y V M.M D D) <br /> _.: <br /> Y <br />~ <br /> 3.. Street Address - _ ,~ =~SIaie.:Perm <br />,1 lf.Numbe.r„'. <br /> I I <br /> . <br />4. CilY~ ~ '- `6.~SCale` ~ ~ <br />.-i2..'Narilepf Mine%'~.~ ~ <br /> T <br />s. <br /> <br />8. Zlp Code ~ 7. A~a~Code 8. Telephone Number <br />. - ~.. <br />_ ° _ <br />y 7. '~~ <br />. .. <br />13 Gounty Code 14:-State~Co 1 ~ i5 Strata <br />~1 <br />' <br />- <br />_ o _ '#.. <br />16. Slate Aroa Otlice <br />I <br />17.~OSM Fleld ~ ~ : 18. OS,M Area'^,~~`~19~OSM;=," ~ "='~,, ~*la~." : <br />,20. TyPe'of".inspection ;• -2t. Jaint InsPettian <br />Office No.: - <br />~` ICOde) ~~+`~~ +~ ~, Ver .:No':. ~ <br />Of11ce~No: ~ <br />•r••-•SamPle;No: '.:-. ~;~ <br />~ ~ 22 Inspector's ID <br />~ No. <br />.. t <br />_, <br />.tir <br />i <br /> <br />23. Stefua ~ ~ ~~ ~ •.~ 24: Type'ol Actrvity(check applicable oozes). <br />A ~ ~ ~ ~ ~ ,: Type nfrPermii ~ <br />~. <br />~ <br />~ <br />_ <br />• ~ ~ <br />& ~ .~ ~ ~ ~ Mine.Status ICOtle1 ~ A <br />^ Sleep Slope <br />' E ~ AnMracite <br />~~ ~ <br />~ <br />~ <br />~ ~~ 0,- .~ ~Mpuntain Top Rertrovaf F ~~ ~ Federal Lands <br />~ ~ ~ Type~o6.Facllity (Code) <br />~ <br />C ~ <br />~/~7 <br />`!-"' ~ '~ ~' '~ ' ~ ~ ~ '~ ~ ~ ~. <br />C ~ ; ~~ Prime Farmlands ~ <br />'G I-1 .Indian Lands <br />D ~ • 0 Number oh Permilled~ACres ,': - <br /> <br />~ ". ' ~ " <br />~D AtlUxlal'V alley FlOprs. <br />" ^, <br />H Other <br />:~ <br />. E • Numbar•ol Disturbed <br />Abres ~ <br />~ . <br />h- <br />r <br />k. <br /> <br />" <br />n <br />_ <br />. <br />~ v <br />25. Performance Standartls lCOdes: '` ~ A '`' <br />. '~. Y: <br />InatructWn•: Intlicate portipliance cotle. For any standartl marketl 2 gr-3 <br />s p'rov~oe~narrauve to support tnis oererminatinn. , <br />.. <br />Slantlarda Thal Limit the Effects to the Permit Area •~ ~ <br />` Stangartls That Assu•e Reclamation OuSlity antl <br />Timeliness <br />A , Q Distance f•rohibilions .N ~'TOpsoil Handling <br />e ~ Mining Within Permit Boundaries ~ . N n Back'iil~r~q ano Grading . <br />L{ <br />J <br />C n Signs and Markers ~ <br />44 <br />----'' ,FOllowmg Reclantetion Sched~ae <br />~ <br />O I <br />D <br />~ <br />'SeAiment Control Measures ~ Z <br />, <br />E"~1 . I Revegelahon Requirements <br />~~ <br />FFYj <br />LLL <br />E n Design antl Cartlficalion Requlrements- . <br />Disposal of Excess Spoil <br />O <br />-- <br />``'-YY Sedlmenl Control <br /> <br />F .n Effluent Llmlls ~ .~ <br />'' <br />~~ R Handling of Acid or Toxic Materials <br />ff-- <br />G a Surface Water Monltoring S n Hlghwall Elimination <br />r+-+ <br /> <br />H © Grounq Water Monltoring ~ T O Oownslope Spoil Disposal <br />A r G, - ~ . f ' :=~' <br /> <br />I ~ Blasting Procedures ~( 1 ~ <br />c 1 n <br />U 4~ Post Mining Lantl Use <br />4J <br />V ~ Cessation of OperaLOns Temporary. <br />. J n Haul/Access Road Design and Maintenance <br />4-' <br />W ~ Other <br />_ <br />K a Refuse Impoundments ,t ~n + `~, ~rh~, r, c [.~ r„1 <br />~Y " <br />L ~ Other: Specify <br />Distribution: Original ~.F ieltl Office, Green ~ HeatlquarterS, Blue ~ State's Copy. Yellow ~ Inspector's Copy. Pink ~ File Copy IE - 163 (1/83) <br />