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T <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: T~o4c G-~l,~o~n. Date: p (o - OQ-. OS <br />NPDES ID. No.:CO-0000213 Date Last Inspected : O 3 -14r-OS <br />Facil ity Configuration: Total Incised Pond <br />Site Name: Impoundment #0014 Location: 47N16W SEC 31 <br />Mine Name: New Horizon Mine Location: l mi.NW of Nucla , CO. <br /> <br />Mine ID No.: CDMG 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) <br />3. Compaction according to approved plan ~ No N/A <br />4. Burning (specify extend and location) Yea ~ 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: Yea ~o 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 downateam foundation area Yea ® 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 OT aCrapB on Slope Yea (~ N/A <br />9. Sloughing or bulging on slope Yes ~ N/A <br />10. Major erosion problems Yes NC.D N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ NIA <br />12. Erosion Of toe Yes ~ N/A <br />13. Water impounded against toe Yes ~ N/A <br /> ~ <br />14. Existing embankment freeboard (feet) ~ _ Feet <br />15. Cracks, bulging, or erosion on upstedm face Yes ® N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ® N/A <br />1'l. Clogging <br /> a) Spillway channels and pipes Yes 1~ N/A <br /> b) Decant system Yea ~ <br />' N/A <br /> C) Diversion Ditches Yes /~., <br />/;1 <br />~yyy N/A R <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes N~ N/A <br /> b) Decant system Yes ® N/A <br />19. Trash racks clear and in place ~ No N/A <br />C~ ~0.~ ~ 1h 1C~~~ <br />-'1'r c. Gc <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />