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PERIODIC INSPECTION FORM <br />Yater, Sedi~ent, ar S•lurry I~oundrents <br />INSPECTOR'S NAME: ~Q~,.k:s ~~ w ~ s <br />N.P.D.E.S. I.D. ND.: cn_nnnro~l n.P_ nna <br />FACILITY CONFIGUtATION: Crnss-Valley Pond <br />SITE NAME: Cnuth i:artinn 17 Pnnd !ln04 <br />MINE NAME: Cenera~TT Mina (Paahndy Coal Companvl <br />MINE I.D. (~,; C.MIRR Permit Nn. C_n05-RD <br />DATE: /I' ~ ~' S tI <br />DATE LAST INSPECTION: ~~ 3 1 • $ `1 <br />LOCATION: SW~SE~_ Sec. 12. T5N. R87W <br />LOCATION: 7.1 mi. SE of Havden. CO <br />OWNER'S REP.: Don Zulian. Suot. <br />Clrcle or ~Irite in appropriate response <br />1. Foundation preparation (removal of vegetation, stumps, topsoil?) <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan <br />4. Burning (specify extent and location) NiA <br />5. Angle Of Slope {~deg+~ 5.1 urctraam 9~1 dnwnctraam, otal <br />6. *Seepage (specify location, color, and approximate volume) <br />From underdrain pipes <br />At isolated points on embankment s opes <br />At natural hillside <br />Over widespread areas <br />From downstream founds ion 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. *Erosion of toe <br />13. *Water impounded against toe <br />14. Existing embankment freeboard (feet) o,~ ~-«~-,~ ~~ <br />15. / Increase Decrease in water level (feet) <br />16. Cracks, bulging, or erosion on upstream face <br />17. Visible sumps or sinkholes in slurry surface N/A <br />Ye No <br />~2_ inches <br />Yes No <br />1)N(S(X74A9( <br />= Jr1 ~~ <br />® Nst <br />Yes fill <br />Yes <br />Yes <br />Yes <br />Yes o <br />Yes ~ <br />Yes <br />Yes <br />Yes ~ <br />Yes <br />Yes No <br />Yes <br />$ feet <br />Qj_ feet <br />Yes <br />k')k1N(XN~Ib <br />18. *Clogging <br />Spillway channels and pipes Yes ~ <br />Decant system Yes <br />Diversion ditc es Yes <br />19. <br />20 <br />*Cracking or crushing of pipes <br />Spillway pipes <br />Decant system <br />Trash racks clear and in place <br />Yes <br />Yes <br />A 1(if3tXXNif <br />*Ma~or adverse changes in these items could cause instability and should be reported 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 />