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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : mss G <br />b1~ Date : o <br />3 <br />(~ C <br /> 0 <br />,, - <br />}- - . <br />NPDES ID. No.:CO-0000213 005 Date Last Inspected : ll- bl- o S <br />Facil ity Configuration:Incised Pond <br />Site Name: Impoundment #012 -LOCation:47N16W Sec-36 <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owner s Rep.: R. L. Wade. Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ~ No N/A <br />2. Lift thickness (inches) ~Z In1 fl <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 slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdrain pipes: Yes ~1 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 stram or ponded water Yes / <br />~ N/A <br />7. Cracks or scarps on crest Yea ® N/A <br />S. Cracks or scraps on slope Yes ~ N/A <br />9. Sloughing or bulging on slope Yes ($a N/A <br />10. Major erosion problems Yes ~ N/A <br />li. Surface movements in valley bottom or on hillside Yes ~ N/A <br />12. Erosion of toe Yea ® N/A <br />13. Water impounded against tce Yes CNe' N/A <br />14. Existing embankment freeboard (feet) ~ ~ Feet <br />is. 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 ~' NJA <br /> c) Diversion Ditches Yes ~ N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yea ~ N/A <br /> b) Decant system Yes ~ N/A <br />19. Trash racks clear and in place Ye No N/A <br />po.,a , s D`'a <br />3, /¢~ o~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />