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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: )~s.5 ~~ok~ Date: ~Z - O~ - O 4- <br />NPDES ID. No.:CO-0000213 Date Last Inspected: 9- ~1- O <br />Facility Configuration: Cross Valley Pond <br />Site Name: Impoundment #007 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Fouadat ion Preparation (removal of vegetation, s <br />tamps., topsoil) ® No N/A <br />2. / <br />Lift thickness (inches) ~ z /Nc !i <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 ® N/A <br /> b.) At isolated points on embankment slopes: Yes ®. N/A <br /> c) At natural hillside: Yes No N/A <br /> d) Over widespread areas Yes No N/A <br /> e) From downsteam foundation area Yes ~ N/A <br /> f) "Soils" beneath at ram or ponded water Yes ©o N/A <br />7. Cracks or scarps on crest Yes ® N/A <br />8. Cracks or scrape on elope Yea ® N/A <br />9. Sloughing or bulging on slope Yea ® N/A <br />10. Major erosion problems Yea ~ N/A <br />11. Surface movements in valley bottom or on hillside Yes ~ N/A <br />12. Erosion Of toe Yea ® N/A <br />13. Water impounded against toe Yes ~ N/A <br /> l <br />14. Existing embankment freeboard (feet) ~ Q Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ~ N/A <br />16. Visible sumps Or ainkhol es in slurry surface Yes ® N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes NO N/A <br /> b) Decant system Yes ® N/A <br /> c) Diversion Ditches Yes ® N/A <br />1E. Cracking or crushing of pipes <br /> a). Spillway pipes Yes ~ N/A <br /> b) Decant system Yes ~ N/A <br />19. Trash racks clear and in place Ye No N/A <br />Po+~D ( s D ~ sc~~,~.~~~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br /> <br />