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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : ~o ~~ ~~~~~Q Date : _ ~ 110 O Z _ <br />NPDES ID. No.:CO-0000213 Date Last Inspected: p ~ o'l <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 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 Mana er <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1• Foundation Preparation (removal of vegetation, stumps., topsoil) tip No N/A <br />2• Lift th' <br /> ickness (inches) <br />3. Compaction according to approved plan <br /> <br />4• <br />Burning (specify extend and location) Yes <br /> <br />Yes No <br /> <br />~ N/A <br /> <br />N/A <br />5• Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a•) From underdrain pipes: <br />Yes <br />~ <br />N/A <br /> b•) At isolated points on embankment slopes: <br />Yes <br />N/A <br /> c) At natural hillside: <br /> <br />d) Over widespread areas Yes ~ N/A <br /> <br />e) From downsteam foundation area Yes ® N/A <br /> <br />f) "Boils" beneath strain or ponded water Yes ~ N/A <br /> <br />7• <br />Cracks or scarps on crest Yes ~ N/A <br /> <br />8• <br />Cracks or scraps on slope Yes ® N/A <br /> <br />9• <br />Sloughing or bulging on slope Yes ~ N/A <br /> <br />10. <br />Major erosion problems Yes ® N/A <br /> <br />il. <br />Surface movements in valley bottom or on hillside Yes ~ N/A <br /> <br />12. <br />Erosion of toe Yes ~ N/A <br /> <br />13. <br />Water impounded against toe Yes ~ N/A <br /> <br />14. <br />Existing embankment freeboard (feet) Yes ~ N/A <br />15. Cracks, bul in or erosion on u steam face <br />g g~ p ~ <br />Yes <br />I@ Feet <br />N/A <br />16. Visible sumps or sinkholes in slurry surface <br />Yes <br />~ <br /> <br />1~• <br />Clogging N/A <br /> a) Spillway channels and pipes <br />Yes <br />® <br />N/A <br /> b) Decant system <br /> <br /> <br />c) Diversion Ditches <br />Yes ~ N/A <br /> <br /> <br />18. <br /> <br />Cracking or crushing of pipes <br />Yes ® N/A <br /> a) Spillway pipes <br /> <br />b) Decant system Yes ~ N/A <br /> <br /> <br />19• <br /> <br />Trash racks clear and in place <br />Yes ~ N/A <br /> ~. No N/A <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />_~ ~vv c ~ <br />