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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Z2es5 G.l~~c,,, Date: b3 - ~ ~ - O~ <br />NPDES ID. No.:C0-0000213 Date Last Inspected: ~~ _ off- 05 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla. CO. <br />Mine ZD No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine Manaaer <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ® No N/A <br />2. Lift thickness (inches) Sz. ~ N GQ. <br />3. Compaction according to approved plan Ye No N/A <br />4. Burning (specify extend and location) Yea ~ N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br />7. <br />8• <br />9. <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />18 <br />19 <br />(~oND IS <br />F:\8ng\DATA\WP\pond-banks\DAMFORM.wpd <br />N/A <br />®p N/A <br />N/A <br />a.) From underdrain pipes: Yes ~ 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 ~ N/A <br />f) "Boils" beneath strain or poaded water Yes ~ N/A <br />Cracks or scarps on treat - Yes ~ ~ N/A <br />Cracks or scraps on slope Yea ~ N/A <br />Sloughing or bulging oa elope Yea ~ N/A <br />Major erosion problems Yes Q N/A <br />Surface movements in valley bottom or on hillside Yes ® N/A <br />Erosion of toe Yes ®, N/A <br />Water impounded against tce Yes Nor N/A <br /> <br />existing embankment freeboard (feet) , ~ <br />7 i <br />Fee[ <br />Cracks, bulging, or erosion on upateam face Yes ~ N/A <br />Visible sumps or sinkholes in slurry surface Yes ~ N/A <br />Clogging <br />a) Spillway channels and pipes Yes <br />b) Decant system Yes <br />c) Diversion Ditches Yes <br />Cracking or crushing of pipes <br />a) Spillway pipes Yea <br />b) Decant system Yes <br />Trash racks clear and in place `` <br />3 - ~~~ O G <br />N/A <br />N/A <br />No N/A <br />