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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : Z _ ~ ~~~b~ Date : q _ q_ D ~{- <br /> <br />NPDE S ID. No.:CO-0000213 Date Last Inspected: (o-3-O ~ <br />Faci lity Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:4 6N15W SEC 6 <br /> <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br /> <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. Foundation Preparation (removal of vegetation, stumps., topsoil) Yea No N/A <br />2. Lift thickness (inches) ~Z /N~ G <br />3. Compaction according to approved plan Ye No N/A <br />4. Burning (specify extend and location) Yes ~ N/A <br />5. Angle of elope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> d.) From nndeldla In pipe9: Yea ~ N/A <br /> b.) At isolated points on embankment elopes: Yes ~ <br />~" ' N/A <br /> c) At natural hillside: Yes NCyI N/A <br /> d) Over widespread areas Yes No N/A <br /> e) FiOm downateam foundation area Yes NO N/A <br /> f) ^HOils" beneath stram or ponded water Yes ~ N/A <br />7. Cracks or scarps oa crest Yes ~ N/A <br />8. Cracks OI 9CIdpa OR Slope Yes ~ N/A <br />9. Sloughing or bulging on slope ~ Yes ~ 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 Yes No N/A <br />13. Water impounded against toe Yes ' ~ 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 No 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® N/A <br /> b) Decant System Yes ~ N/A <br />19. Trash racks clear and in place Ye No N/A <br />~v N L.) ~ s J7~ScScr~o~ ` ^ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />!"'~- ~~1 <br />