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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~~~~~bt-. Date: (~-ZJ-zw <br />NPDES ID. No.:CO-0000213 002 Date Last Inspected:.3•z9,~D~ <br />Facility Configuration:Side Hill Pond <br />Site Name: Impoundment #002 Location:97N15W31CB <br />Mine Name: New Horizon Mine Location:2 mi NW of Nucla CO <br />Mine ID No.: CMLRD Permit #0008-B1 <br />Owners Rep.: R. L. Wade, Mine Manager <br />I <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 />19. <br />15. <br />16. <br />17. <br />18 <br />19 <br />CIRCLE OR WRITE IN APPROPRIAT E RESPONSE <br />Foundation Preparation (removal oC vegetation, stumps., topsoil) Y~ No <br />Lift thickness (inches) <br />Compaction according to approved plan ® No <br />Burning (specify extend and location) Yes (~ <br />Angle of slope: 3:] upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.l From underdrain pipes: Yes <br />b.l A[ isolated points on embankment slopes: Yes N~ <br />U At natural hillside: Yes Ilo <br />U) O'J?f videsptedd dred5 Yes QJ <br />el From downs team foundation area Yes Jo <br />f) "Boils" beneath stram or ponded eater Yes No <br />Cracks or scarps on crest Yes J'o <br />Cracks or scraps on slope Yes No <br />Sloughing or bulging on slope Yes <br />Major erosion problems Yes ft~ <br />Surface movements in valley bottom or on hillside Yes <br />Erosion of toe Yes Nq <br />water impounded against toe Yes / 1~ <br />Existing embankment freeboard (feet) _~ _ <br />Cracks, bulging, or erasion on upsteam face Yes <br />Visible sumps or sinkholes in slurry surface Yes Qo <br />Clogging <br />al Spillway channels and pipes Yes <br />bl Decant system Yes <br />c) Diversion Ditches Yes <br />Cracking or crushing of pipes <br />al Spillway pipes Yes YYd <br />b) Decant system Yes <br />Trash racks clear ani ~ No <br />/pnd llr J//U <br />c: \data \.~pdata \damform.doc <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/n <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 />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 />-L/- 2~ ~ <br />