Field Inspection Report

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					                             FIELD INSPECTION REPORT 

       Bureau of Mine Reclamation, 2051 East Dirac Drive, Tallahassee, FL 32310-3760
          Ph: (850) 488-8217 SC: 8-8217 Fax: (850) 488-1254 SCFax: 278-1254
             Note to Inspectors: One inspection report must be filled for each mine per day in the field.

MINE NAME:

LOCATION (TOWN):




DEP INSPECTOR:                                               DATE OF INSPECTION:
                                (signature)
OTHER ATTENDEES:



MINE REPRESENTATIVE:
                                (signature)

        Conservation Easement Area                      Permitting Area

INSPECTION
NOTES:




                                                                                 Field Inspection Report
                                                                                 Reclamation Form No. 5
                                                                                        Page 1 of 2 Pages
INSPECTION NOTES (continued:)




                                Field Inspection Report
                                Reclamation Form No. 5
                                       Page 2 of 2 Pages
Field Inspection Report
Reclamation Form No. 5
       Page 3 of 2 Pages