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PERIODIC INSPECTION FORM <br />' ~ Yater, Sediment, or Slurry Impoundments <br />INSPECTOR'S NAME: ~ v~...; s JaN.~~ S <br />N.P.D.E.S. I.D. NO.: rn-nnnn~~T n.P. nna <br />FACILITY CONFIGLRATION: Cross-Valley Pond <br />SITE NAME: cniith cartinn 17 Pnnd Hnn4 <br />MTNE NAME: canary TT Mina (Paahn Coal Comoanv) <br />M[NE I.D. NO.: cMieA Parmit Nn. f.-nnS-An <br />DATE : c] - ~1 - `~ S <br />DATE LAST INSPECTION: 6 • /D '15,5 <br />LOCATION: SW'aSE'a. Sec. 12. T5N. R87W <br />LOCATION: 7.1 mi. SE of Hayden. CO <br />OWNER'S REP.: Don Zulian. Supt. <br />Circle or write in appropriate response <br />1. Foundation preparation (removal of vegetation, stoops, topsoil4) <br />2. Lift thickness (inches) <br />Ye No <br />~2_ inches <br />Yes No <br />~(~(~(XXrA9C <br />5. Angle of slope{'de9~'~ 5~1 urstraam, 7c1 downstream. total = 1:.1~ <br />6. *Seepage (specify location, color, and approximate volume) <br />3. Compaction according to approved plan <br />4. Burning.(specify extent and location) N/A <br />from underdrain pipes <br />At isolated points on embankment s opes <br />At natural hillside <br />Over widespread areas <br />From downstream founds on area <br />Boils" beneath stream or ponde water <br />7. Cracks or scarps on crest <br />8. Cracks or scarps on slope <br />9. Sloughing or bulging on slope <br />10. *Mafor erosion problems <br />11. Surface movements in valley bottom or on hillside <br />12. *Erosian of toe <br />13. *Water impounded against toe <br />14. Existing embankment freeboard (feet) c,,J~ ~~9 o c~,.~.u-~v) <br />15. Increase v~ Decrease in water level (feet) ` <br />16. Cracks, bulging, or erosion on upstream face <br />17. Visible swops or sinkholes in slurry surface <br />A <br />18. *Clogging <br />Spillway channels and pipes <br />Decant system <br />Diversion ditc es <br />19. <br />*Cracking or crushing of <br />Spillway pipes <br />Decant system <br />20. Trash racks clear and in place N/A <br />No <br />Yes Qj~ <br />Yes <br />Yes Quo <br />No <br />Yes <br />~~ No <br />1~E9 No <br />Yes (~ <br />Yes <br />Yes I~o <br />Yes to <br />Yes No <br />5! feet <br />D~ feet <br />Yes No <br />)0'x~(X XVb <br />Yes <br />Yes (F~~ <br />Yes <br />Yes ~p <br />Yes o <br />x88xxN8 <br />*Ma,~or adverse changes in these items could cause inst~ d should be reported to <br />iu~uen i eon Derr euerinn <br />the Engineering Manager and Mine Superinten luation. Adverse condi- <br />tions noted in these items should normally location, volume, etc.) <br />in the space on the bAck of this sheet. <br />JAM 231986 <br />pipes <br />