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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY <br />Inspectors Name: ~o~t G~.~~ Date: ~~ - Ol - 05 <br />NPDES ID. No.:C0-0000213 Date Last Inspected : p9-Z2- 6S <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:4 6N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla , CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine Manacxer <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) I Z 1 k tQ <br /> <br />3. , <br />Compaction according to approved plan <br />Ye <br />No <br />N/A <br />4. Burning (specify extend and location) Yes No 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 Q N/A <br /> b.) At isolated points on embankment slopes: Yea ~ N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yes ® N/A <br /> e) From dOwila Ceam 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 />S. Cracks or scraps on slope 'Yes (F~1 N/A <br />9. Sloughing or bulging on slope Yes ~ N/A <br />10. Maj oY erosion problems Yes ~ N/A <br />il. 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 <br />1 ~~ 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 /> a) Spillway pipes Yes ® N/A <br /> b) Decant system Yes ®° N/A <br />19. Trash racks clear and in place ~e No N/A <br />r 0?(d ( 5 Yld~ ~ iS GhP~s ~n~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />