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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~ ss ~~'~„~~ Date: (3~ - zz - oS' <br />NPDES ID. No.:CO-0000213 Date Last Inspected:b~-69-oS <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #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 /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps.,~topsoil) ~! No N/A <br />2. Lift thickness (inches) ~ 2 iiy~ <br />3. Compaction according to approved plan Ye No N/A <br />4. Burning (specify extend and location) Yea [~ 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 slopes: Yes C~ N/A <br /> c) At natural hillside: Yes t~ NJA <br /> d) Over widespread areas Yes ~ N/A <br /> e) Piom downsteam foundation area Yes ® N/A <br /> f) "Boils" beneath strain or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest ~ Yes ® N/A <br />e. Cracks or scraps on slope Yes ~> N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. MajoY erosion problems Yea ~ N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ N/A <br />12. EY0810n of toe Yea ~ N/A <br />13. Water impounded against toe Yea ~ N/A <br />14. Existing embankment freeboard (feet) ~n ~ Fee[ <br />15. Cracks, bulging, OY erosion on upsteam face Yes N/A <br />16. Vie ible 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 Yea ~ N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ~ N/A <br /> b) Decant system Yes ~ N/A <br />19. Trash racks clear and in place ~ No N/A <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />~^ Zz <br />