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<br />PERIODIC INSPECTION FORM <br />WATER, .SEDIMENT, OR SLURRY IMPOUNDMENTS <br /> Lift thickness (inches) <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 slope: 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 Ts N/A <br /> d) Over widespread areas Yes ® N/A <br /> e) From downsteam foundation area Yes ~ N/A <br /> f) "Boils" beneath stram or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />8. Cracks or scraps on slope Yes ® N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes ® N/A <br />11. Surface movements in valley bottom or on hillside Yes NO N/A <br />12. Erosion of toe Yes ®° N/A <br />13. Water impounded against toe Yes ~ N/A <br />14. Existing embankment freeboard (feet) ~ <br /> <br />15. <br />Cracks, bulging, or erosion on upsteam face / ~ <br />Yes <br />®. Feet <br />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 Qo N/A <br /> b) Decant system Yes ~1 N/A <br />19. Trash racks clear and in place ~ No N/A <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #O11 Location:46N16W SEC 1 <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. Foundation Preparation (removal of vegetation, stumps., topsoil) ~ No N/A <br />2 <br />Inspectors Name : ~~~ C~-~L~a Date :_~ n~s~ ~ o-l <br />NPDES ID. No.:CO-0000213 Date Last Inspected: Zo '~~.} o't <br />Ne.w Cov.3-~r~~~t ~o ~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />,~e~ 01 <br />'Za <br />