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PERIODIC INSPECTION FORM <br />Yater, Sediment, or Slurry Impoundments <br />INSPECTOR' S NAME: ~ o ~„ ~..: 5 -~ o ~, o ~ DATE: ~ 5 - ~ 3 - `6 <br />N.P.D.E.S. I.D. NO.: <br />FACILITY CONFIGURATION: Crnss-Vallav Pond DATE LAST INSPECTION: f(- Z y ~ y <br />SITE NAME: Cn~ith Cart inn 17 Dnnr1 irnn4 LOCATION: SW'~SE'a. Sec. 12. T5N. R87W <br />MINE NAME: Canary TT Mina jPaabndy Coal Comoanvl LOCATION: 7.1 mi. SE of Hayden. CO <br />MINE I.D. NO.: f.MIRR Parmit Nn. r-nnC-Rn OWNER'S REP.: pon Zulian. Suot. <br />Circle or write in appropriate response <br />1. Foundation preparation (removal of vegetation, stumps, topsoil7) Ye No <br />2. Lift thickness (inches) ~2_ inches <br />3. Compaction according to approved plan Yes No <br />4. Burning (specify extent and location) N/A YiW(S(XX~9( <br />5. Angle of s10pe {'dCQ*!M~ r,~l nnctraam 7~1 dnwnstream, total = ~I~ <br />6. *Seepage (specify location, color, and approximate volume) <br /> From underdrain pipes fey No <br /> At isolated points on embankment s opes Yes WD <br /> At natural hillside Yes ito <br /> Over widespread areas Yes Fe+ <br /> From downstream founds Ton area Yes i4o <br /> "Boils" beneath stream or ponde water Yes <br />7. Cracks or scarps on crest Yes <br />8. Cracks or scarps on slope Yes ~ <br />9. Sloughing or bulging on slope Yes ~a <br />10. *Ma~or erosion problems Yes (I~b <br />11. Surface movements in valley bottom or on hillside Yes Vo <br />12. *Erosion of toe es No <br />13. *Water impounded against tae Yes ~ND7 <br />14. Existing embankment freeboard (feet) S feet <br />15. Increase Decrease in water level (feet) v feet <br />16. Cracks, bulging, or erosion on upstream face Yes to <br />17. Visible sumps or sinkholes in slurry surface N/A )D'ki5~(Xklb <br />18. *Clogging <br /> Spillway channels and pipes Yes Flo <br /> Decant system Yes <br /> Diversion ditc es Yes <br />19. *Cracking or crushing of pipes <br /> Spillway pipes Yes <br /> Decant system Yes <br />20. Trash racks clear and in place N/A X~f~lX XN~f <br />*Ma,lor adverse changes in these items could cause instability and should be repo rted to <br />the Engineering Manager and Mine Superintendent for further evaluation. Adverse condi- <br />tions noted in these items should normally be described (extent, location, volume , etc.) <br />in the space on the back of this sheet. <br />