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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~„y~ G,_,b1c~ Date: Iz-ZI- ~,.,~, <br />NPDES ID. No.:CO-0000213 009 Date Last Inspected: 9-Z,Z-. Zox <br />Facility Configuration:Side Hill Pond <br />Site Name: Impoundment #009 Location:47N16W36CB <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucla. CO. <br />Mine ID No.: CMLRD Permit #0008-B1 <br />Owne rs Rep.: R. L. Wade. Mine Mana-ecr_r <br /> CIRCLE OR WRITE IN APPROPRIAT E RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ~ No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan ~ No N/A <br />4. Burning (Specify extend and locatronl Yes ~ N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify Location, co to z, and approx. volume) <br /> a.) From undo[drain pip es: Yes ® N/A <br /> b.) At isolated points on embankmenC slopes: Yes ~ N/A <br /> cl At natural hillside: Yes ~o N/A <br /> d) Over widespread areas Yes ® N/A <br /> e~ FCOm tlownstedm foundation a[ea Yes ® N/A <br /> f) "Boils" beneath scram or ponded water 1'es ~ N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />8. Cracks or scraps on slope Yes ~ N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes ® N/A <br />11. Surface movements in valley bot COm Or on hillside Yes @ N/A <br />12. Erosion of toe 'tes L~ N/A <br />13. Water impounded against toe Ye s 1 ~ N/A <br /> t <br />14. Existing embankment freeboard (feet) 1 <br />11 L FeeC <br />15. Cracks, bulging, or erosion on upsteam face Yes ® N/A <br />16. Visible sumps or Sinkholes in Slurry surface Yes Q N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes Q° N/A <br /> b) Decant system Yes ~ N/A <br /> c) Diversion Ditches Yes ® N/A <br />18. Cracking or crushing of pipes <br /> a~ Spillway pipes Yes ® N/A <br /> b) DECdnt System YES ® N/A <br />19. Trash rac YS clod[ and rn place ~ No N/A <br />~Or+~ lb ~~ <br />c:\data\wpdata\damform.doc <br />Z ,. •z I - Z~ <br />