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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~~s ~`u,p~,, Date: p („~OOt- Q S <br />NPDES ID. No.:CO-0000213 005 Date Last Inspected : N.Q ~„~ p~~,p <br />Facility Configuration;Incised Pond <br />Site Name: Impoundment #012 Location:4 7N16W Sec 36 <br /> <br />Mine Name: New Horizon Mine Location:2 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., topsoil) ~ No N/A <br />2. Lift thickness (inches) ~'t, i n~ e <br />3. Compaction according to approved plan Q No N/A <br />9. Burning (specify extend and location) Yes ~ 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 Flo N/A <br /> b.) At isolated points on embankment elopes: Yes ~ N/A <br /> c) At natural hillside: Yes ® N/A <br /> d) OveY widespread areas Yes ~ N/A <br /> e) From downsteam foundation area Yes ®O N/A <br /> f) "Boils" beneath stram or ponded water Yes ®° N/A <br />7. Cracks or scarps on crest Yes ® 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. Erosion of toe Yes ~, N/A <br />13. Water impounded against toe Yes No N/A <br />14. Existing embankment freeboard (feet) ~~ Feet <br />15. Cracks, bulging, or erosion on up st eam face Yes ® N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ~. N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes ~ N/A <br /> b) Decant system Yes ®~ 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 Yes ~ N/A <br />19. Trash racks clear and in place ~ No N/A <br />1~ont9 ~5 ~~~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />01-o9-aS <br />