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PERIODIC INSPECTION FORM <br />Mater, Sedi~ent, or Slurry I~poundnents <br />INSPECTOR'S NAME: IOe ~ ~ : ~ ~,,,. Q 5 DATE: 6 - ~ 5 - ~ `j <br />N.P.D.E.S. I.D. NO.: rn-nnnm~T n_P_ nna <br />FACILITY CONFIGUtATION: Cross-Valley Pond DATE LAST INSPECTION: 3 'S ' `a `~ <br />SITE NAME: cnuth cartinn T7 Pnnd #nna LOCATION: SWaSEa. Sec. 12. T5N. R87W <br />MINE NAME: canary TT Mina (Peahn Coal Comoanvl LOCATION: 7.1 mi. SE of Hdvden. CO <br />MINE I.D. NO.: CMIRR Parmit Nn. r-nnS-Rn OWNER'S REP.: Don Zulian. Soot. <br />Circle or write in apprropriate response <br />1. Foundation preparation (removal of vegetation, stoops, topsoill) Ye No <br />2. Lift thickness (inches) ~Z inches <br />3. Compaction according to approved plan Yes No <br />4. Burning (specify extent and location) NiA 11c~(XX~,9( <br />5. Angle of slope {~deelrs~ S•1 urctraam 9~1 downstream. total = ]~ b~ <br />6. *Seepage (specify location, color, and approximate volume) <br /> From underdrain pipes © No <br /> At isolated points on embankment s opes Yes <br /> At natural hillside Yes o <br /> Over widespread areas Yes <br /> From downstream foundation area © No <br /> "Boils" beneath stream or ponde water Yes ®o <br />7. Cracks or scarps on crest Yes <br />8. Cracks or scarps on slope Yes <br />9. Sloughing or bulging on slope Yes ®o <br />10. *Ma~or erosion problems Yes No <br />11. Surface movements in valley bottom or on hillside Yes <br />12. *Erosion of toe Yes N® <br />13. *Water impounded against toe Yes No <br />14. Existing embankment freeboard (feet) ~ ~.~~~Q~.,~, o $ feet <br />15. / Increase Decrease in water level (feet) <~ feet <br />16. Cracks, bulging, or erosion on upstream face Yes No <br />17. Visible sumps or sinkholes in slurry surface N/A )~(XXib <br />18. *Clogging <br /> Spillway channels and pipes Yes <br /> Decant system Yes <br /> Diversion ditc es Yes ®o <br />19. *Cracking or crushing of pipes <br /> Spillway pipes ® No <br /> Decant system Yes <br />20. Trash racks clear and in place __ __ N/A XS~XXNN <br />*Ma~or adverse changes in these items could cause instability and should be reported to <br />the Engineering Manager and Mine Superintendent for further evaluation. Adverse condi- <br />tions noted in these items should normally be described (extent, location, volume, etc.) <br />in the space on the back of this sheet. <br />