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<br />PERIODIC INSPECTION FORM <br />WATER, SIDIl~~N'!', OR SLURRY IMPOI7N!)MEI~TPS <br />Inspectors Name: ~~ ~~~~ Date: ~z_ ~a~_ ctp, <br />NPDES ID. No.:CY~-0000213 006 Date Last Inspected: ~_lo- q o, <br />Facility Configuration:Cross Valley Pond <br />1. Foundation Preparation (removal of vege[ation, stumps., topsoil) ~ No N/A <br />2. Lif[ thickness (inches) <br />3. Camaction according to approved plan ® No N/A <br />4. Burning (specify extend and locat ionl Yes ofd N/A <br />5. tvigle of slope: 3~1 upstream, ~ downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From, unde.rdrain pipes: Yes Qr3 N/A <br /> h.) At isola[ed points on embankment slopes: Yes ® N/A <br /> c) A[ natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yes ® N/P. <br /> e) Frcm downstream foundation area Yes ® N/A <br /> fl "Boils" beneath scream or ponded wa[er Yes ® N/A <br />~. Cracks or scarps on crest Yes !~. <br />! <br />yy N/A <br />B. Cracks or scraps on slope Yes Q~ N/A <br />9. Sloughing or bulging on slope Yes d~0 N/A <br />10. Major erosion problems Yes ~ N/A <br />11. Surface movements in valley bottom or on hillside Yes Q~ N/A <br />12. Erosion of tce Yes ~ N/A <br />13 Water impounded against tce Yes , ~-iGl N/A <br />14. Existing embankment freeboard (feet) Feet <br />15. Cracks, bulging, or erosion on upstream face Yes No N/A <br />16. Vrsible sunq~s or sinkholes in slurry surface Yes N N/A <br />17. Clogging <br /> al Spillway channels and pipes Yes ~pL~ N/A <br /> b) Decant system Yes ~ N/A <br /> c) Diversion Ditches Yes ~ N/A <br />18. Cracking or crushing of pipes <br /> a1 Spillway pipes Yes C~ N/A <br /> b) Decant system Yes ~ N/A <br />19. Trash racks clear and in place ~ No N/A <br />Site Name: Impoundment #006 Location:47N16W36AC <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucla. m . <br />Mine ID No.: CP'Q~RD Permit #0008-81 <br />Owners Rep.: R. L. Wade Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />TO r.~ 1 $ ho ~. Q~S Cane~~`a~ <br />~~'lq=~i`~i <br />