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?4 <br />PERIODIC INSPECTION FDRM <br />Mater, Sedi~ent, or Slurry I~poundments <br />INSPECTOR'S NAME: Dw`~ ~- _J a k~s <br />N.P.D.E.S. I.D. NO.: cn-nnnn22l n_P_ nna <br />FACILITY CONFIGl1FtATION: Cross-Valley, Pond <br />SITE NAME: Cnuth Cactinn 12 Pnnd #nn4 <br />MINE NAME: SPnPCa TT Mina (Paahn Cnal Cnmoanvl <br />MINE I.D. NO.: ('MIRR Parmit Nn_ C-nn5-RD <br />DATE: ~~-2 S1- 03 <br />DATE LAST INSPECTION: <br />LOCATION: SW'aSE~. Sec. 12. T5N. R87W <br />LOCATION: 7.1 mi. SE of Havden. CO <br />OWNER'S REP.: Don Zulian. Suot. <br />Circle ar Mrite 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 {lke,~lN~ Sal up,5traam 2~l downstream. total <br />6. *Seepage (specify location, color, and approximate volume) <br />From underdrain pipes <br />At isolated points on embankment 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 <br />10. *Major erosion problems <br />slope <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 />Ye No <br />~~ i nches <br />Yes No <br />~fS(X)G'AQ( <br />= Z:1 ~rss~ <br />Yes o <br />Yes o <br />Yes <br />Yes <br />Yes N <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes ~N <br />Yes No <br />Yes <br />Yes <br />(feet) , hc~ti. n7ycc~~~cY~c c w~c~~su~~eu.....L~- feet <br />_~ <br />15. Increase Decrease in water level (feet) N~ 1:eei;- <br />16. Cracks, bulging, or erosion on upstream face Yes No <br />17. Visible sumps or sinkholes in slurry surface N/A W~(XNib <br />18. *Clogging <br />Spillway channels and pipes Yes <br />Decant system Yes <br />Diversion ditc es Yes <br />19. *Cracking or crushing of pipes <br />Spillway pipes Yes <br />Decant system Yes <br />20. Trash racks clear and in place N/A XAHXXNS <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 />