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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~s C~~O. Date: 3-Zqw 7yol <br />NPDES ID. No.:CO-0000213 009 Date Last Inspected:~Z-Z1-ZA00 <br />Facility Configuration:Side Hill Pond <br />Site Name: Impoundment #009 Location: 97N16W36C B <br />Mine Name: New Horizon Mine Location: 2 mi.NW o f Nuc la. CO. <br /> <br />Mine ID No.: CMLRD Permit #0008-61 <br />Owne rs Rep.: R. L. Wade. Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation ([emoval of vegetation, stumps., topsoil) ~ No N/A <br />2. Li E[ thickness (inches) <br />3. Compaction according to approved plan es No N/A <br />4. Burning (specify extend and location) Yes No N/A <br />5. Angle of slope: 3:1 upst[eam, 3:1 dovnst ream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) F[Om unde[drain pipes: Yes ~ N/A <br /> b.) AC isolated points on embankment slopes: Yes ~ N/A <br /> c) At naCU ral hillside: Yes ~ N/A <br /> d~ Over widespread areas Yes ~ N/A <br /> e) From downsteam foundation area Yes F~7o7~ N/A <br /> fl "Boils" beneath s[ram 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 Ny N/A <br />]0. Major erasion problems Yes ~ N/A <br />11. Surface movements in valley bottom of on hillside Yes ~, N/A <br />12. Erosion of Coe Yes ~ N/A <br />13. Hater impounded against toe Yes ~ ) IN/A <br />ld. Existing embankment freeboard (feet) _ 1 i Feet <br />15. Cracks, bulging, or e[osion on upsteam face Yes ® N/A <br />16. Visible Sumps or sinkholes in Slurry surface Yes ~p N/A <br />17. Clogging <br /> al Spillway Channels antl 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 /> al Spillway pi Yes ~ N/A <br /> b) Decant syst Yes ~ N/A <br />19. Trash raCk9 cleat 2 ~ No N/A <br />\ 15 Y ~~ <br />~U r`d <br />c:\da to\wpda[a \damform.doc <br /> <br />