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<br />PERIODIC INSPECTION FORM <br />WATER, SIDIMENT, OR SLURRY <br />Inspectors Name: }~„~ ~,~,~ Date: )z. <br />NPDES ID. No.:CO-0000213 007 Date Last Inspected: q -)~_~R <br />Facility Configuration:Cross Valley Pond <br />Site Name: Impoundment #007 Location:47N15W6 <br />Mine Name: Neal Horizon Mine Location:2 mi.NW of Nucla. CO. <br />Mine ID No <br />Owners Rep.: R. L. Wade Mine Man?aer <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (rertaval of vegetation, stumps., topsoil) ~ 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 ~ 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 Qp1 N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes ® N/A <br /> d) Over widespread areas Yes ~ N/A <br /> el Fran downstream foundation area Yes ® N/A <br /> f) "Boils" beneath scream or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />8. Cracks or scraps on slope Yes Qd N/A <br />9. Sloughing or bulging on slope _ Yes ~ N/A <br />10. Major erosion problems Yes ® N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ N/A <br />i2. Erosion of tce Yes ® N/A <br />13. Water impounded against tce Yes ® N/A <br />19. _ <br />Existing embai~lanent freeboard (feet) 7~ Feet <br />15. Cracks, bulging, or erosion on upstream face Yes ~ N/A <br />16. Visible sins or sinkholes in slurry surface Yes ® N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes Q1 N/A <br /> b) Decant system Yes (~! N/A <br /> c) Diversion Ditches Yes ~ N/A <br />18. Cracking or crushing of pipes <br /> ai Spillway pipes Yes 1~ N/A <br /> b) Decant system Ye <br />s ® N/A <br />15. Trash racks clear and in place _ ^ <br />t;ea No N/A <br />HEG/S~ <br />NIS ~,GFy1c <br />~,o <br />~ Z. <br />