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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~~rs G,~bSG. <br />NPDES ID. No.:CO-0000213 <br />Date : O S- 08 - o G <br />Date Last Inspected: ~, 3 -) ~a ~ <br />Facility Configuration: Total Incised Pond <br />Site Name: ImDOUndment #009 Location:47N16W SEC 36 <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 />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />11. <br />12. <br />13. <br />14, <br />15. <br />16. <br />17 <br />18. <br />19 <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />Foundation Preparation (removal of vegetation <br />, stumps., ~topaoil) Yea No N/A <br />f~ <br />Lifi thickness (inches) ~ 2 ~ w CSL _ <br />Compaction according to approved plan T Ye No N/A <br />Burning (specify extend and location) Yee ~ N/A <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />Seepage (specify location, color, sad approx. volume) <br />a.) FYOm underdraia pipes: Yes ~ N/A <br />b.) At isolated points on embanlmtent slopes: Yes ~ N/A <br />c) At natural hillside: Yes ~ N/A <br />d) Over widespread areas Yes ® N/A <br />e) FYOm downateam foundation area Yes ® N/A <br />f) 'Boils" beneath strain or ponded water Yes ~ N/A <br />Cracka~or scarps on crest Yes ® . N/A <br />Cracks or scraps on slope ~ Yes ~ N/A <br />Sloughing or bulging on slope Yes ~ N/A <br />Major erosion problems Yes ~ N/A <br />Surface movements in valley bottom or on hillside Yes ® N/A <br />Erosion of toe - Yes ~ N/A <br />Nater impounded against toe Yes ® N/A <br />Existing embanlanent freeboard (feet) ~o , Feet <br />Cracks, bulging, or erosion on upeteam face Yes ® N/A <br />Visible sumps or sinkholes in aluirv surface Yea /~ N/A <br />Clogging <br />a) Spillway channels and pipes Yea <br />b) Decant system Yes <br />c) -Diversion Ditches Yes <br />Cracking or crushing of pipes <br />a) Spillway pipes Yea <br />b) Decant system Yes <br />Trash racks clear and in place <br />~p.n O, ~' ~ roc <br />F:\Eng\DATA\wP\pond-banks\DAMFORM.wpd <br />N/A <br />®a N/A <br />® N/A <br />~_ o$ . o!o <br />® N/A <br />Qyl N/A <br />