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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name:~Q~ G,,,~jka, Date: ~ Z ^O'1- 0 4 <br />NPDES ID. No.:CO-0000213 Date Last Inspected: Q - q- O 4 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:4 6N15W SEC 6 <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 R ESPONSE <br /> <br />1. Foundation Preparation (removal of vegeta <br />t ion, stumps., topsoil) ~ No N/A <br />2. /~ <br />Lift thickness (inches) ~~ /nl~l. <br />3. Compaction according to approved plan ~ No N/A <br />4. Burning (specify extend and location) Yes No N/A <br />5. Angle of elope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdrain pipes: Yes No N/A <br /> b.) At isolated points on embankment slopes: Yes N N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yea No N/A <br /> e) From downsteam foundation area Yea ~ N/A <br /> f) "Boils" beneath stram or ponded water Yes IQ~ N/A <br />7. Cracks or scarps on crest Yes ~~ N/A <br />e. Cracks or scraps on slope Yea I~i N/A <br />9. Sloughing or bulging on elope Yes ^ <br />~~4./ N/A <br />10. Major erosion problems Yes ~ N/A <br />11. Surface movements in valley bottom or on hil hide Yes ~ N/A <br />12. Erosion of toe Yes ~ N/A <br />13. WateY impounded against toe Yes ~ ~ N/A <br />l4. Existing embankment freeboard (feet) _~ Feet <br />15. CYack s, bulging, Or erosion On up steam face Yes No N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes ~ N/A <br /> b) Decant system Yes ® 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 Yea ® N/A <br />19. Trash racks clear and in place ~ No N(A <br />S'rn o ~ 1 q rno v n-~- o ~ W cx~-e r ~ nl ~o ~ om <br />pontO \S Y\~T ~\ SICMGr'~~~g, <br />F:\Eng\DATA\WP\pond-banks\DAMFOEM.wpd <br /> <br />