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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~ s~ G ~~~. Date: I\- o1-0.S <br />NPDES ID. No.:CO-0000213 ~ Date Last Inspecte d: 0°1- 2Z-OS <br />Facil ity Configuration:Incised Pond <br />Site Name: Impoundment #012 Location:4 7N16W Sec 36 <br />Mine Name: New Horizon Mine Location:2 mi.NW o f Nucla, CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owner s Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE R ESPONSE <br />1. - Foundation Preparation (removal of vegetation, stum <br />ps., tops oil) ~ No N/A <br />2. p <br />Lift thickness (inches) ~ L IevN(_ <br />3. Compaction according to approved plan Ye No N/A <br />4. Burning (Specify extend and location) Yea ~ 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 ~ N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yea (ISM N/A <br /> e) From downsteam foundation area Yes (~ N/A <br /> f) "Boils" beneath stram or ponded water Yes (ID N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />e. Cracks or scraps on slope Yes t®. N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yea ® N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ N/A <br />12 .. Erosion of toe Yes ~ NIA <br />13. Water impounded against toe Yes ® N/A <br /> <br />14. <br />Existing embankment freeboard (feet) <br />-j 1 <br />Feet <br />15. Cracks, bulging, or erosion on upsteam face Yea ® 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 T <br />1ay$ N/A <br />1E. 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 ~Ye~1 No N/A <br />ron0 15 ~~~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />~(-ot-o5 <br />