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PERIODIC INSPECTION FORM <br />`~_ Mater, Sediment, or Slurry Impoundments <br />INSPECTOR'S NAME: 1.1~~~~ s ~o k.Q 5 <br />N.P.D.E.S. I.D. NO.: cn-nnnro~T n_P_ nn3 <br />FACILITY CONFIGURATION: piked Pond <br />SITE NAME: ~Inrthwact Tmonundmant #003 <br />MINE NAME: Sanara TT Mina (Peahndy Coal Comoanvl <br />MINE I.D. NO.: CMIRR Parmit No_ C-005-RO <br />DATE: ~-7'~j Z~ <br />DATE LAST INSPECTION: I~-~Sf- $3 <br />LOCATION: SEaSW~. Sec. 27. T6 N, R87W <br />LOCATION: 7.1 mi. SE of Havden. CO <br />OWNER'S REP.: Don Zulian. Soot. <br />Circle or write in appropriate response <br />1. foundation preparation (removal of vegetation, stumps, topsoil?) <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan <br />4. Burning (specify extent and location) N/A <br />5. Angle of Slope ~YYp~ 7'1 unctraam, 3c1 dnwnstream_ total <br />6. *Seepage (specify location, color, and approximate volume) <br />From underdrain pipes <br />At isolated points on em ankment s opes <br />At natural hillside <br />Over widespread areas <br />From downstream foundation area <br />"Boils" beneath stream or ponde water <br />7. Cracks or scarps on crest <br />8. Cracks or scarps on slope _ <br />9. Sloughing or bulging on slope <br />10. *Major erosion problems <br />11. Surface movements in valley bottom or on hillside <br />12. *Erosion of toe <br />13. *Water impounded against toe <br />14. Existing embankment freeboard <br />15. Increase Decrease <br />Yes No <br />~Z inches <br />Yes No <br />X1C~XXl9fP <br />_ ~:.L ~e9reer. <br />XRnxxNi~ <br />Yes o <br />Yes o <br />o <br />Yes <br />Yes No <br />Yes o® <br />Yes <br />Yes <br />Yes No <br />Yes No <br />Yes No <br />(feet) ~ ccow <br />- iD y o clucQps <br />-o N*PwSU~Fwe "~( feet <br />in water level (feet) Q feet <br />16. Cracks, bulging, or erosion on upstream face Yes <br />17. Visible somas or sinkholes in slurry surface N/A Xd%XXNdf <br />18. <br />*Clogging <br />Spillway channels <br />Decant system <br />Diversion ditcl'~es <br />19. *Cracking or crushing of pipes <br />Spillway pipes <br />Decant system <br />20. Trash racks clear and in place N/A <br />Yes <br />Xl4i(XXNfA <br />Yes ~o <br />Yes o <br />X~iiIX <br />Xdi(XXlld <br />*Major adverse changes in these items could cause instability and should be reported to <br />the Engineering Manager and Mine Superintendent for further evaluation. Adverse condi- <br />tions noted in these items should normally be described (extent, location, volume, etc.) <br />in the space on the back of this sheet. <br />and pipes <br />