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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />POND <br />Porto <br />Inspectors Name:-~~ ~~ Date: ~l- ol- OS <br />NPDES ID. No.:CO-0000213 Date Last Inspected : Oy - Z Z -OS <br />Facility Configuration: Cross Valley Pond <br />Site Name: Impoundment #007 Location:4 6N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br /> <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine Manacrer <br />CIRCLE OR WRITE IN APPROPRIATE R ESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., tops oil) Yes No N/A <br />2. Lift thickness (inches) 1 Z. Ini cS. <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 underdzain pips: Yes ~ N/A <br />b.) At isolated points On embankment slopes: Yes ® N/A <br />C) At naCUra1 hillside: Yes ~ N/A <br />d) - Over widespread areas Yes ® N/A <br />e) From downst eam foundation area Yes ® N/A <br />f) "Boils" beneath stram or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />8. Cracks or scraps on slope - Yes ~ N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Maj OY erosion problems Yes (~ NjA <br />11. Surface movements in valley bottom or on hillside Yes ® N/A <br />12. Erosion of toe Yes ~ N/A <br />13. Water impounded against toe Yes ® N/A <br />14. Existing embankment freeboard (feet) ~ _ 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 />18. Cracking or crushing of pipes <br /> <br />a) Spillway pipes <br />Yes ^ <br />[lt9f <br />N/A <br />b) Decant system Yes ~o N/A <br />19. Trash racks clear and in place ~ No N/A <br />,1 <br />15 ~~S ~srS ~n, V~4 ~.•Se.\ Pv µ~'D• <br />due ~o cue ~o,tr <br />IS ~w.Q°~' ~°"'.. <br />g <br />LN E~eo~r,o ea M\ <br />F:\Eng\DATA\Wp\pond-banks\DAMFORM.wpd <br />~~_ o/- o S <br />