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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : ~aS~ G,1y,1~, Date : O 3 - I ~ - oS <br />NPDES ID. No.:CO-0000213 Date Last Inspected: IZ-o2 -~'~' <br />Facility Configuration: Cross Vallev Pond <br />Site Name: Impoundment #007 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owne rs Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESP ONSE <br />1. Foundation Preparation (removal of <br />v <br />egetatio/n/, stumps., topsoil) Ye No N/A <br />2. , <br />y <br />Lift thickness (inches) / /. i i~/^J~ <br /> <br />3. Compaction according to approved plan Y~. No N/A <br />4. Burning (specify extend and location) Yes Ny7 N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdrain pipes: Yes No N(A <br /> b.) At isolated points on embankment slopes: Yes ~ N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yes ~ N/A <br /> e) From downsteam foundation area Yes ~ NJA <br /> f) "Boils" beneath stram oz ponded water Yes No N/A <br />7. Czacks or scarps on crest Yes ~ N/A <br />8. CLack6 OY 90rapS On 910pe Yes 1~ N/A <br />9. Sloughing or bulging on slope Yes ~lo N/A <br />10. Major erosion problems Yes io N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ N/A <br />12. Erosion of toe Yes ^ <br />l~ N(A <br />13. Water impounded against toe Yes !~ N/A <br />14. Existing embankment freeboard (feet) ~ Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ~ <br />N N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes N/A <br /> b) Decant system Yes N/A <br /> c) Diversion Ditches Yea ® N/A <br />18. Cracking or crushing of pipes <br /> d) Spillway pipes Yes ~ N/A <br /> b) Decant system Y <br />es ~ NJA <br />19. Trash racks clear and in place es <br />) <br />( Yeyg No N/A <br />F:\Eng\DATA\WP\pond-bank a\DAMFORM.wpd <br />