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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: 1~~ss ~ bk. Date: q _ 2~ -do <br />NPDES ID. No.:CO-0000213 001 Date Last Inspected: (o-Z~_oa <br />Facility Configuration:Cross Valley Pond <br />Site Name: Impoundment #001 Location:97N16W36BC <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucla. CO. <br />Mine ID No.: CMLRD Permit #0008-81 <br />Owners Rep.: R. L. Wade. Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of /vegetation, stumps., topsoil) ~ No N/A <br />2. Lift thickness (inches) ~ / A <br />1 <br />3. Compaction according to approved plan Yes No N/A <br />4. Burning (specify extend and location) Yes ~ N/A <br />S. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br />7. <br />B. <br />9. <br />10 <br />11 <br />12 <br />13 <br />19 <br />15 <br />16 <br />17 <br />18 <br />19 <br />a.l From underdrain pipes: Yes Q <br />b.) A[ isolated points on embankment slopes: Yes No <br />cl At natural hillside: Yes ®o <br />d) Over widespreatl areas Yes No <br />e) From downsteam foundation area Yes <br />f) "Boils" beneath s[ram or ponded water Yes No <br />Cracks or scarps on crest Yes ®j <br />Cracks or scraps on slope Yes N~ <br />Sloughing or bulginq on slope Yes J~r <br />Major erosion problems Yes <br />Surface movements in valley bottom or on hillside Yes ~D <br />Erosion of toe Yes <br />water impounded against toe Yes ~ ®~ <br />Existing embankment freeboard (feet) . ~ <br />Cracks, bulging, or erosion on upsteam face Yes <br />Visible sumps or sinkholes in slurry surface Yes No <br />Clogging <br />a) Spillway channels and pipes Yes <br />b) Decant system Yes <br />c) Diversion Ditches Yes <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes <br />b) Decant system Yes <br />Trash racks clear and in place <br />c:\data\wptlata\damform.doc <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />N/A <br />N~ N/A <br />©o N/A <br />N/A <br />N/A <br />N/A <br />9-zz.. <br />