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<br /> <br />PERIODIC INSPECTION FORM <br />Pater, Sedi~ent, or Slurry I~poundments <br />INSPECTOR'S NAME: <br />N.P.D.E.S. I.D. NO.: rn-nnnro~T n_P_ nna <br />FACILITY CONFIGURATION: Crnss-Vallev Pond <br />SITE NAME: Smith Sartinn 19 Pnnd lf004 <br />MINE NAME: Sanaca TT Mina (Paahn Coal Comoanvl <br />MINE I.D. NO.: CM~RR Parmit Nn. c-nns-Ro <br />DATE: <br />DATE LAST INSPECTION: <br />LOCATION: SW~SE%. Sec. 12. TSN. R87W <br />LOCATION: 7.1 mi. SE of Havden. CO <br />OWNER'S REP.: ~qn Zulian. Supt. <br />Circle or write in appropriate response <br />1. Foundation preparation (removal of vegetation, stumps, topsoil?) Ye No <br />2. Lift thickness (inches) ~_ inches <br />3. Compaction according to approved plan Yes No <br />4. Burning (specify extent and location) __ N/A YX9(~(XX~'~9C <br />5. Angle Of s10pe deg*~ 5.1 nnctraam, 9:1 dnwnstream_ total = ~1'de~Mee~ <br />6. *Seepage (specify location, color, and approximate volume) <br /> From underdrain pipes Yes No <br /> At isolated points on embankment s opes Yes No <br /> At natural hillside Yes No <br /> Over widespread areas Yes No <br /> From downstream foundatTOn area Yes No <br /> "Boils" beneath stream or ponde water Yes No <br />7. Cracks or scarps on crest Yes No <br />8. Cracks or scarps on slope Yes No <br />9. Sloughing or bulging on slope Yes No <br />10. *Major erosion problems Yes No <br />11. Surface movements in valley bottom or on hillside Yes No <br />12. *Erosion of toe Yes No <br />13. *Water impounded against toe Yes No <br />14. Existing embankment freeboard (feet) _ feet <br />15. Increase Decrease in water level (feet) _ feet <br />16. Cracks, bulging, or erosion on upstream face Yes No <br />17. Visible sumps or sinkholes in slurry surface N/A (XXOb <br />18. *Clogging <br /> Spillway channels and pipes Yes No <br /> Decant system Yes No <br /> Diversion ditc es Yes No <br />19. *Cracking or crushing of pipes <br /> Spillway pipes Yes No <br /> Decant system Yes No <br />20. Trash racks clear and in place N/A XS~XXN~ <br />*Major adverse changes in these items could cause instability and should be reported to <br />the Engineering Manager and Mine Superintendent for further evaluation. Adverse condi- <br />tions noted in these items should normally be described (extent, location, volume, etc.) <br />in the space on the back of this sheet. <br /> <br />