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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLIIRRY IMPOIINDMENTS <br />Inspectors Name:~~~,,~ ~,1Sa Date: 7p11y~.Ls: a'l <br />NPDES ID. No.:CO-0000213 Date Last Inspected:h -s.,n~ o`t <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:) mi NW of Nucla. CO. <br />Mine.ID No.: CDMG Fermit #0008-81 <br />Owners Rep <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />10 <br />19 <br />R. L. Wade, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />Foundation Preparation (removal of vegetation, stumpa.,~topaoil) Y® No <br />Lift thiclmeas (inches) <br />Compaction according to approved plan Ye No <br />Earning (specify extend and location) Yes <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />seepage (specify location, color, and approx. voles) <br />a.) Prom underdrain pipes: Yes <br />b.) At isolated points on embaa3~ent B1ope6: Yes <br />c) At natural hillside: Yes <br />d) Over widespread areas Yes <br />e) From downsteam Foundation area Yes ~. <br />f) 'Boils" beneath strain or ponded valet Yes <br />Cracks'or scarps oa crest Yes ~. <br />Cracks oc scraps on slope ~ Yes <br />sloughing or bul9iug on slope Yes <br />Major erosion problems Yes <br />Surface movements is valley bottom or on hillside Yes ~ <br />Erosion of tce ~ Yes <br />Hater impounded against tce Yes ® <br />Existing embaNm:en[ freeboard (feet) es <br />.__-.[ A <br />~ <br />Cracks, bulging, or erosion on upsteam face Yes <br />Visible sins or sinkholes in. slurry surface Yes <br />Clogging <br />a) Spillway charnels and pipes Yes ~, <br />b) Decant system Yes <br />c) Diversion Ditches ~ Yes N <br />Cracking or crushing of pipes <br />a) Spillway pipes Yea <br />b) Decant system Yes <br />Trash racks clear and in Yes No <br />~ar.0~ • S ~C~ <br />N/A <br />N/A <br />N(A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N(A <br />N/A <br />N/A <br />N/A <br />NIA <br />Feet <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N(A <br />N/A <br />N/A <br />.~/'JVS <br />F:\Eng\DATA\F7P\pond-banks\DAMFOR <br />