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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : {~ ss „ bkR Date : o S - O S - o (o <br />NPDES ID. No.:CO-0000213 005 Date Last Inspected: O 3 -14 -O~c <br />Facility Configuration:Incised Pond <br />Site Name: Impoundment #012 Location:47N16W Sec 36 - <br />Mine Name: New Horizon Mine Location:2 mi <br />NW of Nucla <br />CO <br /> . , <br />. <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) Ye No N/A <br />2• Lift thickness (inches)_ +Z ~ N Q <br />3• Compaction according to approved plan ~ No N/A <br />4. Burning (specify extend and location) <br />Yea <br />No <br />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 uaderdrain pipes: Yes ® N/A <br /> b.) At isolated points on emban]®ent elopes; 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) "eoiia• beneath strain oz poaded water Yes ~ N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />8. <br />~ Cracks or scraps on slope Yes ® N/A <br />9• Sloughing or bulging oa elope ~ yes ~ N/A <br />lo, Major erosion problems Yes ~ N/A <br />il, Surface movements in valley bottom or on hillside Yes ~ N/A <br />12. Erosion of tce - Yes ~ N/A <br />13. <br />14 Water impounded against tce Yes ~ N/A <br />. Existing embanlanent freeboard (feet) ~ <br /> <br />15. <br />Cracks, bulging, or erosion on upsteam face ~ <br />Yes <br />N pest <br />N/A <br />16. Visible sumps or sinkholes in slurry surface Yea N~ N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yee ~ 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 Yea ~ N/A <br /> bl Decant system Yes ® N/A <br />19. Trash racks clear and in place ~e , No N/A <br />~o..O )5 ~1"~ <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />s mss- o~ <br />