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PERIODIC INSPECTION FORM <br />Water, Sediment, or Slurry Impoundments <br />INSPECTOR'S NAME: M'cha 7 A7 avilla DATE: 09/25 ~47 <br />NPDES I.D. NO.: co-0000221 O.P. 004 <br />FACILITY CONFIGURATION: -roes-Nall X Pond_ DATE LAST INSPECTION: D6/27~~_ <br />SITE NAME: South section 12 Pond X004 LOCATION: SW_~y~ Sec. 12 TSN" R87W <br />MINE NAME: s n ca it Min (c n.ca oa7 -ol LOCATION: 7.t mi. SR oi= Hayden ~_ <br />MINE I.D. NO.: r_ r.Rn P m+ No. -80-005 OWNER'S REP.: Brad Brown, Gen Mg~_ <br />1. Foundation preparation (removal of vegetation, stumps, topsoil: ee No N/A <br />2. Lift thickness: ~_ in. N/A <br />3. Compaction according to approved plan: ~ No N/A <br />4. Burning (specify extent and location): Yes No /~ <br />5. Angle of elope: 5:1 upstream, 2:1 downstream Total = 7:1 N/A <br />6. *Seepage (specify location, color, and approximate volume) <br /> From underdrain pipes: Yee o N/A <br /> At isolated points on embankment elopes: Yes N/A <br /> At natural hillside: Yes N/A <br /> Over widespread areas: Yes o N/A <br /> From downstream foundation area: Yea N/A <br /> "Boils" beneath stream or ponded water: _ Yes o N/A <br />7. Cracks or scarps on treat: Yes ® N/A <br />8. Cracks or scarps on elope: Yee ® N/A <br />9. Sloughing or bulging on elope: Yes N/A <br />10. *Maj or erosion problems: Yes ~ N/A <br />11. Surface movements in valley bottom or on hillside: Yee o N/A <br />12. *Eroeion of toe: Yes ~~~ N/A <br />13. *Water impounded against toe: Yee ~ <br />o N/A <br />14. Existing embankment freeboard: see comments 5.8 feet <br />15. Increase Decrease in water level: No chance feet <br />16. Cracks, bulging, or erosion on upstream face: Yea Qo N/A <br />17. Visible sumps or sinkholes in slurry surface: Yes No <br />18. *Clogging <br /> Spillway channels and pipes: Yee ®o N/A <br /> Decant system: Yee N® N/A <br /> Diversion ditches: Yee No <br />19. *Cracking or crushing of pipes <br /> Spillway pipes: Yes ~ N/A <br /> Decant system: Yes ~ N/A <br />20. Trash racks clear and in place: ea No N/A <br />*Major adverse changes in these items could cause instability and should be reported to the <br />Engineering Manager and Mine Superintendent for further evaluation. Adverse conditions noted <br />in these items should normally be described (extent, location, volume, etc.) in the space on <br />the back of this sheet. <br />