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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: )~~ ~nb~ Date: 09 ~ Lz-oS <br />NPDES ID. No.:CO-0000213 Date Last Inspected :pE,- 09-0$ <br />.Facil ity Configuration: Total Incised Pond <br />Site Name: Impoundment #0014 Location:47N16W SEC 31 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla . CO. <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, atumps., eopsoil) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan ~ No N/A <br />4. Burning (specify extend and location) Yes No N/A <br />S. Angle o£ slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.l From underdrain pipes: Yes ® N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yea .`A~ N/A <br /> d) Oyez widespread areas Yes ~, N/A <br /> e) From downsteam foundation area Yee L"~ N/A <br /> f) "Boil a" beneath stram or ponded water Yea ® N/A <br />7.~ Cracka oz scarps on crest Yes ~ N/A <br />8. Cracks or scraps on slope ~ Yes ~ N/A <br />9. Sloughing or bulging on slope Yes C~ N/A <br />10. Major erosion problems Yes ® N/A <br />11. Surface movements in valley bottom or on hillside Yea Ali N/A <br />12. Erosion of tce Yes Id N/A <br />13. Water impounded against toe Yes <br />~ ~ N/A <br />14. Existing embankment freeboard (feet) L Feet <br />15. Cracks, bulging, or erosion on upateam face Yea ~ N/A <br />16. Visible sumps or sinkholes in slurry surface Yes Ny N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes ~ N/A <br /> b) Decant system Yes J~ 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 Yes ~ NjA <br />19. Trash racks clear and in place ~ No N/A <br />P°No /5 ~~~ <br />F:\Eng \DATA\WP\pond-banks\DAMFORM.wpd <br />J <br /> <br />