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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : <br />~ <br />C <br />~~ Date • 9- Zz - Q S <br /> " <br />s~ <br />~ <br />p <br />NPDES ID. No.:CO-0000213 Date Last Inspected: b6-o`j'-~S <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:4 6N15W 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 APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., tops oil) ® No N/A <br />2. Lift thickness (inches) ~~ /k~ <br />3. Compaction according to approved plan ~ No N/A <br />4. Burning (specify extend and location) Yes ~ N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdrain pipes: Yes ® N/A <br /> b.) At isolated points on embankment 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 .mac N/A <br /> f) "Boils" beneath strain or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest - Yes ~ N/A <br />8. CrdCks Or aC rape On BlOpe Yea NO N/A <br />9. Sloughing or bulging on slope Yea C® N/A <br />10. Major erosion problems Yes Q N/A <br />11. Surface movements in valley bottom or on hills ids Yes Flo N/A <br />12. Erosion of toe Yes C$W? N/A <br />13. Water impounded against toe Yes ale N/A <br />14. Existing embankment freeboard (feet) Fee[ <br />15. Cracks, bulging, or erosion on upsteam face Yea N N/A <br />16. Visible sumps or sinkholes in slurry surface Yes No N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes No N/A <br /> b) Decant system Yes N/A <br /> c) Diversion Ditches Yes ^~ <br />cam' N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes (~ N/A <br /> b) Decant system Yea /~ <br />07Y N/A <br />19. Trash racks clear and in place ~ No N/A <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />a5 <br />ia.. z2" <br />