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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~~ a G"~~ Date: n S -OR - o ~ <br />NPDES ID. No.:CO-0000213 Date Last Inspected: O 3-~4 _p(e <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 APPROPRIATR RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ~ No N/A <br />2. Lift thickness (inches)- 'Z ~ , - <br />3. Compaction according to approved lea F <br />P <br />y9 <br />No <br />N/A <br />a. 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: Yea ® N/A <br /> b.) A[ isolated points on embankwent slopes: Yes ~ N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yes ® N/A <br /> e) From downsteam foundation area Yes ~ N/A <br /> f) ^HOils° beneath atram or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />8. Cracks or scraps on slope Yes ®. N/A <br />9. Sloughing or bulging on elope Yea ~ N/A <br />10. Maj OL erosion problems Yes ~ N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ N/A <br />12. Erosion of tce Yes ~ N/A <br />13. Water impounded against tce Yes ®• N/A <br />14. Existing embankment freeboard (feet) ~ ~ Fee[ <br />15. Cracks, bulging, or erosion on upgteam face Yea ~ 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 ~ N/A <br /> c) Diversion Ditches Yes ~ N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ® N/A <br /> b) Decant system Yea 7~j~ N/A <br />19. Trash racks clear and in place es No N/A <br />rnh0~ 15 h6'~' 3~1Sc.MOr~ih~ <br />~5- a8-~4 <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />