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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~s ~,~,~~ Date: OQ- 14-Ow <br />NPDES ID. No.:CO-0000213 Date Last Inspected:~~5-08,0 <br />Facility Configuration: Total Incised Pond - <br />Site Name: Impoundment #008 Location:46N15W SEC 6 <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 RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) l.=l~' No N/A <br />2. Lift thickness (inches) ' 7. . Nf•~. <br />3. Compaction according to approved plan xe No N/A <br />4. Burning (specify extend and location) Yes ~ N/A <br />5. Angle of elope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: Yes G.~ N/A <br />b.l At isolated points on embanlaaent slopes: Yea ~ N/A <br />- c) At natural hillside: Yes ~ N/A <br />d) Over widespread areas Yes ~ N/A <br />e1 From dowasteam foundation area Yes l.~O N/A <br />f) °BOils' beneath strain or goaded water Yea ~ N/A <br />7. Cracks or scarps on crest Yes f~ N/A <br />8. Cracks or scraps on slope Yes ~ N/A <br />9. Sloughing or bulging on slope Yea ~ N/A <br />10. Major erosion problems Yes <¢~ N(A <br />11. Surface movements in valley bottom or on hills ids Yes Q~ N/A <br />12. Srosion of tce Yes ® N/A <br />13. Water impounded against tce Yea ® N/A <br />l4. 8xisting emban]®ent freeboard (feet) ~_ Feet <br />15. Cracks, bulging, or erosion on upateam 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 ~0 N/A <br />c) Diversion Ditches Yea ,T`1~ N/A <br />18. CYacking 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 O RE(, Ye No N/A <br />C yr~ °P'~~W'S CG~9F <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />q~ /¢-C4 <br />