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PERIODIC INSPECTION FORM <br />Water, Sediment, or Slurry Impoundments <br /> <br />INSPECTOR'S NAME: Ron Gehrke DATE: 11/21/91 <br />NPD ES I.D. NO.: - D.P. 004 <br />FAC ILITY CONFIGU Cross-Valley Pond DATE LAST INSPECTIO N: 08 /01/91 <br />SIT E NAME: South Section 12 Pond #004 LOCATION:SW'(,SE'/., Sec.~ ~ R8 7W <br />MIN E NAME: eneca the ea o y oa o LOCATION; mt. o ay en, <br />MIN E I.D. N .: ermtt - - OWNER'S R .~coCt WWilliams, Sup t <br /> Circle or write in appropriate response <br />1. Foundation preparation (removal of vegetation, stumps, topsoil): _ © No N/A <br />2. Lift thickness: 12 in. N/A <br />3. Compaction according to approved plan: es No N/A <br />4. Burning (specify extent and location): Yes No N A <br />5. Angle of slope: 5:1 upstream, 2:1 downstream Total = 7:1 N/A <br />6. *Seepage (specify location, color, and approximate volume) <br /> From underdrain pipes: Yes No N/ <br /> At isolated points on em an men s opes: Yes o N A <br /> At natural hillside: Yes o N/A <br /> Over widespread areas: Yes o N/A <br /> From downstream foundation area: Yes N N/A <br /> "Boils" beneath stream or ponded wa er: Yes No N/A <br />7. Cracks or scarps on crest: Yes ® N/A <br />8. Cracks or scarps on slope: Yes No N/A <br />9. Sloughing or bulging on slope: Yes ® N/A <br />10. *Major erosion problems: Yes ©o N/A <br />11. Surface movements in valley bottom or on hillside: Yes ® N/A <br />12. *Erosion of toe: Yes ~ N/A <br />13. *Water impounded against toe: Yes No N/A <br />14. Existing embankment freeboard: 4.7 feet <br />15. Increase Decrease in water level: feet <br />16. Cracks, bulging, or erosion on upstream face: Yes low N/A <br />17. Visible sumps or sinkholes in slurry surface: Yes No <br />18. *Clogging <br /> Spillway channels and pipes: Yes N/A <br /> Decant system: Yes N N/A <br /> Diversion ditches: Yes No N/A <br />19. *Cracking or crushing of pipes <br /> Spillway pipes: Yes ~ N/A <br /> Decant system: Yes o N/A <br />20. Trash racks clear and in place: Yes No N/A <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 />