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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />~racs <br />Inspectors Name: ~o.~~ G~~~ Date : p ~ _ Oq - p5 <br />NPDES ID. No.:CO-0000213 Date Last Inspected: p 3- ~4 -~ <br />Facil ity Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla , CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE R ESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., tops oil) Ye No N/A <br />2. Lift thickness (inches) ~ Z I N c L <br />3. Compaction according to approved plan ® No N/A <br />4. Burning (specify extend and location) Yes N® N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdrain pipes: Yes ~ N/A <br /> b.) At isolated points on embankment slopes: Yes ~ N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yes ~ N/A <br /> e) From downsteam foundation area Yes ~. N/A <br /> f) "Boils" beneath etram or ponded water Yea ® N/A <br />7. Cracks or scarps on crest Yes ©o N/A <br />8. Cracks or scraps on slope Yes ~ N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes ~ N/A <br />11. Surface movements in valley bottom or on hillside Yes ® N/A <br />12. EYOSion of tae Yes ® N/A <br />13. water impounded against toe Yes ® N/A <br />14. Existing embankment freeboard (feet) ~ ~ <br />_ Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N~ N/A <br />16. Visible sumps or sinkholes in slurry surface Yea ® N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes ~ N/A <br /> b) Decant System Yea ® N/A <br /> c) Diversion Ditches Yes ~ N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ® N/A <br /> b) Decant system Yea NO N/A <br />19. Trash racks clear and in place ~ No N/A <br />o~ ~,.,a-k-. ~ , h ~-1~0.~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />GG -a~I-os <br />