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PERIODIC INSPECTION FORM <br />Mater. Sediment, or Slurry Iepoundments <br />INSPECTOR'S NAME: 1I/~v.v-~s ~a~-~.-5 DATE: ~ II `"Zd'8~(o <br />N.P.D.E.S. I.D. NO.: rn-nnnro~l n_P_ nn3 <br />FACILITY CONFIGURATION: nikad Pond DATE LAST INSPECTION: ~(- 2 2 - g ~ <br />SITE NAME: Nnrthwact Tmnoundmant !(003 LOCATION: SE'oSW'e. Sec. 21. T6N. RR741 <br />MINE NAME: Samara Ti Mina (ppabodv Coal ComoanY) LOCATION: 7,I mi. SE of Hayden. CO <br />MINE I.D. NO.: C.MIRR Parmit Nn_ C.-005-AO OWNER'S REP.: Don Zulian, Suot. <br />Circle or write in appropriate response <br />1. Foundation preparation (removal of vegetation, stoops, topsoilZ) Yes No <br />2. Lift thickness (inches) ~_ inches <br />3. Compaction according to approved plan ~ Yes No <br />4. Burning (specify extent and location) NIA XJCFXXIFIi <br />5. Angle Of slope (~de~rea~j 7.1 unctream 3c7 downstream. total = ,r4L~64MEeb <br />6. *Seepage (specify location, color, and approximate volume) <br /> From underdrain pipes XR%XXNIO <br /> At isolated points on embankment s opes Yes ~ <br /> At natural hillside Yes ~fy~ <br /> Over widespread areas Yes <br />~ <br />g <br /> From downstream founds on area g <br />fj <br />Yes <br /> "Boils" beneath stream or ponde water Yes ~ <br />7. Cracks or scarps on crest Yes ~ID <br />8. Cracks or scarps on slope Yes ~ <br />9. Sloughing or bulging on slope Yes ~ <br /> <br />10. *Major erosion problems Yes <br />11. Surface movements in valley bottom or on hillside Yes ~ <br />12. *Erosion of toe Yes ~o <br />13. *Water impounded against toe Yes ®o <br />14. Existing embankment freeboard (feet) S feet <br />15. Increase Decrease in water level (feet) O feet <br />16. Cracks, bulging, or erosion on upstream face Yes ~ <br />17. V151b1e sumps or sinkholes in slurry surface N/A Xrfi;XXNd <br />18. *Clogging <br /> Spillway channels and pipes Yes ~ <br /> Decant system _ _ N/A Xd~XXNdI <br /> Diversion ditc es Yes <br />19. *Cracking or crushing of pipes <br /> II <br />Spillway pipes w-~~ev Le~~ cQ~ek,.~ 6d ~ i-0 e_ <br />~ No <br /> Decant system Ktif7XXp(r~ <br />20. Trash racks clear and in place __ __ N/A K-0fi(XXO(d( <br /> <br />*Major 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 tfiese items should normally be described (extent, location, volume, etc.) <br />in the space on the back of this sheet. <br />