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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMSNT, OR SLIIRRY IMPOUNDMENTS <br />S,,-. a ~, <br />Inspectors Name:~~~ ~bka, Date: \Z- C~(o- o~ <br />NPDES ID. No.:CO-0000213 Date Last Inspected : C~et-I~t--C3~ <br />Facil ity Configuration: Total Incised Pond - <br />Site Name: Impoundment #0014 Location:47N16W SEC 31 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade. Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) Yes ® N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan Ye No N/A <br />4. Burning (specify extend and location) Yes ~ N/A <br />5. Angle of elope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.l From underdraia pipes: Yes ® N/A <br /> b.) At isolated points on embanlwent slopes: Yea ~ N/A <br /> c) At natural hillside: Yes NO N/A <br /> d) Over widespread areas Yea ~ N(A <br /> e) From downsteam foundation area Yea ~ N/A <br /> f) °BOils° beneath strain or ponded water Yes ~ N/A <br />7.~ Cracks oI scarps on crest Yea ~ N{A <br />6. Clacks or scraps oa slope Yes ~ N/A <br />9. Sloughing or bulging on slope Yea ~ N/A <br />10. Maj oz erosion problems Yes ® N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ N/A <br />12. Erosion of tce Yes ~ N/A <br />13. Water impounded against toe Yes 1~ N/A <br />14. Existing embankment freeboard (feet) 3 Feet <br />15. Cracks, bulging, or erosion on upateam face Yes No N/A <br />16. Visible sumps oY sinkholes in slurry surface Yes N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes No ~~ <br /> b) Decant system Yes No <br /> c) Diversion Ditches Yes Nc <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes No (NJ7q <br /> b) Decant system Yes No rL+YL~ <br />19. Trash racks clear and in place Yea No <br /> ~~\\'' <br />F: \Eng\DATA\Wp\pond-banks\DAMFORM.wpd <br /> <br />r - <br />