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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY <br />Inspectors Name: ~oss G.rblCq Date: 3 - Ib-Zccs> <br />NPDES ID. No.:CO-0000213 005 Date Last Inspected: ~2_(,_I~ ~ <br />Facility Configuration:Side Hill Pond <br />Site Name: Impoundment #005 Location:97N16W36AD <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucl a. CO. <br /> <br />Mine ID No.: CMLRD Permit #0008-81 <br />Owners Rep.: R. L. Wade. Mine Manag er <br />CIRCLE OR WRITE IN APP ROPRIATE 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 loca[ionl Yes No 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 underd rain pipes: 'f es ~ N/A <br />b.) AC isolated points on embankment slopes: Yes @ N/A <br />c) AC na[u[al hillside: Yes ~ N/A <br />d) Over widespread areas_ 5'es , No N/A <br />el From dounsteam foundation area Yes @'~, N/A <br />f) "Boils" beneath s[ram of ponded water Yes ~ 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~ N/A <br />10. Major erosion problems Yes ~ 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 <br />1 ~~ N/A <br />14. Existing embankment freeboard (feet) ' - <br />~ <br />,1~ Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ~ N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ®, N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes ~ N/A <br />b) Decant system Yes 4',p~ N/A <br />c) Diversion Ditches Yes ~ N/A <br />18. Cracking or crushing of pipes <br />al Spillway pipes Yes ~A N/A <br />b) Decant system Yes ® N/A <br />19. T[ash tacks clear and in place Ye No N/A <br /> LO RfG~S <br /> T <br />P <br />P.~EWISC F9 <br />\\ <br />~on0 is ~~ ~ :~~ G~.:F~ <br />c:\da [a \wpdata\damform.doc ;0 7~ <br /> ~ <br />4 <br /> G~~ <br />9~ <br /> E~ <br />FSS <br /> rO 1 <br />NA <br />