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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~v5s G,_,~b~~ Date: IZ_21_~~~ <br />NPDES ID. No.:CO-0000213 008 Date Last Inspected: g-Z,-I..LOO.~ <br />Facility Configuration:Cross Valley Pond <br />Si te Name: Impoundment #006 Locatio n:97N15 W6 <br />Mi ne Name: New Horizon Mine Locatio n:2 mi. NW o f Nuc la. CO. <br /> <br />Mi ne ID No.: CMLRD Permit #0008-81 <br />Ow ne rs Rep.: R. L. Wade. Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIAT E RESPO NSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ~ No N/A <br />2. Loft thickness (inches) <br />3. Compaction according to approved plan ~ No N/A <br />4. Burning (specify extend and location) Yes ~70~~ N/A <br />5. Angle of slope: 3:1 upstream, 3:1 dounst ream <br />6. Seepage (specify location, color, and approx. vol umel <br /> a.l From underdrain pipes: Yes ~ N/A <br /> b.) At isolated points on emban Y.ment slopes: Yes ry~m N/A <br /> c) A[ natural hillside: Yes ~ N/A <br /> d) Ove[ widespread areas Yes ® N/A <br /> el From downs[eam foundation ai ea Yes ~ N/A <br /> f) "Boils" beneath s[ram or pond ed water yes L~ N/A <br />7. Crac k.s or Scarps on crest 1'e5 No' N/A <br />8. Crac Y,s or scraps on Slope 1'es ~ N/A <br />9. Sloughing or bulginy on slope Yes ~ N/A <br />10. Major erosion problems Yes tQo N/A <br />11. Surface movements in valley bottom or on hills rde Yes ® N/A <br />12. Erosion of toe Yes ~ N/A <br />13, water impounded against toe Yes y~ <br />CN N/A <br /> _ <br />I <br />14. Existing embankment freeboard (feet) ~ o _ Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes mod. N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ~ IJ/A <br />17. Clogging <br /> al Spillway channels and pipes Y,es ® 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 J <br />o N/A <br /> b) Decant System Yes f <br />1 <br />~ol[J N/A <br />19. Trash racks clear and in place Yes N© N/A <br /> <br />c: \data\wpdata\damform.tloc <br />Z".LI~ Zak <br />