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PERIODIC INSPECTION FORM <br />p0 REG/ <br />S <br />p?P EWIS~,rcg9 <br />.5 G•. <br />U ~~~~ •~ <br />F`rS~inwy <br />~- 9- °`~ <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: /~os5 ~~ ~k5 Date: 9- ~~ O4 <br />NPDES ID. No.:CO-0000213 Date Last Inspected : (0-~3- O ~- <br />Facility C onfiguration: 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 />Owne rs Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. tumpa. <br />Foundation Preparation (removal of vegetation, s , topsoil) ~ No N/A <br />2. ,/ <br />Lift thickness (inches) <br />/7 Nrti <br />3. _ <br />Compaction according to approved plan Yes No N/A <br />4. Burning (specify extend and location) Yea ~ N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> <br />a.) From underdzain pipes: <br />Yes ~ <br />"~`Y <br />N/A <br /> b.) At isolated points on embankment slopes: Yes ~ N/A <br /> c) At natural hillside: Yea ~ N/A <br /> d) Over widespread areas Yes ~Ny7 N/A <br /> e) From downsteam foundation area Yes ® N/A <br /> f) "Boils" beneath stram or ponded water Yes 1~ N/A <br />7. Cracks or scarps on crest i1'~ Yes Nq N/A <br />8. Cracks or scraps on slope Yee ~ N/A <br />9. Sloughing or bulging on slope ;+"r~~ Yes N[~ N/A <br />10. Major erosion problems ~ Yea ® N/A <br />11. Surface movements in valley bottom Or on hillside Yea ~ N/A <br />12. Erosion of toe Yes ~ N/A <br />13. Water impounded against toe Ye ~ N/A <br />14. Existing embankment freeboard (feet) Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ® N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ® 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~y N/A <br /> b) Decant system Yes ~ N/A <br />19. Trash racks clear and in place Ye No N/A <br />pur~/7 /S yi_f~~O,l~n~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />