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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~_~ C~lotiCo. Date: Z.o ill ~ ~ sro`l <br />NPDES ID. No.:CO-0000213 005 Date Last Inspected:~y,-~_„_e.~ <br />Facility Configuration:Incised Pond <br />Site Name: Impoundment #012 I,ocation•47N16W Sec 3b • <br />Mine Name:_New Horizon Mine Location:2 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) ~ No N/A <br />2. Li£t thickness (inches) <br />3. Cou@actioa according to approved plan y~ No N/A <br />1. Burnie (specify extend and location) yea ~ N/A <br />5. Angle of slope: 3:1 upstream, 3:1 dowstream <br />6. Seepage (specify location, color. sad approx. volume) <br /> a.) FYOm usdecdraia pipes: Yes ~ N(A <br /> b.) At isolated poiatc on embanlanent slopes: Yes ~ N/A <br /> C) At natural hillside• Yes ® N/A <br /> d) Over widespread arena Yes ® N/A <br /> e) From downsteam foundation area Yes (~ N/A <br /> ~f) •BOils' beneath strain OL ponded Mater Yes W N/A <br />7. CraCk6 Or SCdIQS Oa Crest Yes ~ N/A <br />8. Cracks or scraps Oa Slope Yes ~ N/A <br />9. - Sloughing or bulging oa slope ~ Yes ~ N/A <br />10. Najor erosion problems ~ Yes _ <br />® N/A <br />11. Surface pavements is valley bottom or on hillside Yes ® N/A <br />12. Erosion of tce ~ Yes ® N/A <br />13 :~ Water impounded against tce Yes ~ N/A <br />14. Existing emban/~eat freeboard (feet) <br />~ <br />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 ~ N/A <br /> c) Diversion Ditches Yes ® N/A <br />- 1S. Cracking or crushing of pipes <br /> a) Spillway pipes Yea ® N/A <br /> b) Decant system Yes ®1 N/A <br />19. Trash racks clear and in place ®e No N/A <br />~o..d +s z"'~s- <br /> <br />F:\Eng\DATA\HP\pond-banks\DAMFORM.wpd <br />Qp'OOyyEGjSTF` <br />0~~4~ 3 GG,9~ <br />~¢ ~ ~c'~ <br />.o ~ ~,v <br />~~~K~JAt~° ?f <br />