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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Z ~` ~,b~ Date: /o-~~_ egg <br />NPDES ID. No.:CO-0000213 005 Date Last Inspected: 3-~S_qq <br />Facility Configuration:Side Hill Pond <br />Site Name: Impoundment #005 Location:97N16W36AD <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucla. CO. <br />Mine ID No.: CMLRD Permit #0008-81 <br />Owners Rep.: R. L. Wade. Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ®e No N/A <br />2 <br />3 <br />4 <br />5 <br />6 <br />7. <br />8. <br />9. <br />10. <br />11. <br />12. <br />13. <br />19. <br />15. <br />16. <br />17. <br />18 <br />19. <br />Lift thickness (inches) <br />Compaction according to approved plan <br />Burning (specify extend and location) <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.1 From untlerdra in pipes: <br />b.I A[ isolated points on embankment slopes: <br />c) At natural hillsrde: <br />d) Over widespread areas <br />e) From downsteam fountlation area <br />f) "Boils" beneath stram or ponded eater <br />Cracks or scarps on crest <br />Cracks or scraps on slope <br />Sloughing or bulging on slope <br />Major erosion problems <br />Surface movements in valley bottom or on hillside <br />Erosion of toe <br />Water impounded against toe <br />Existing embankment freeboard (feet) <br />Cracks, bulging, oc erosion on upsteam face <br />Visible sumps or sinkholes in slurry surface <br />Clogging <br />a) Spillway channels and pipes <br />b) Decant system <br />cl Diversion Ditches <br />Cracking or crushing of pipes <br />aI Spillway pipes <br />b) Decant system <br />Trash racks clear and in <br />~O f1 ~ 1 S ~'r <br />c: \data\wpdata\damform.doc <br />e5 No <br />Yes <br />Yes Jo <br />'Yes <br />Yes to <br />1'es 1® <br />Yes <br />Yes l~ <br />Yes ~. <br />Yes <br />Yes <br />Yes <br />1'e5 <br />Yes <br />Ye1s/ ~~ <br />b <br />Yes N® <br />Yes <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />1'es Ny, N/A <br />Yes (N O' N/A <br />Yes ® N/A <br />Yes ~ N/A <br />Yes l@ N/A <br />N/A <br />