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<br />PERIODIC INSPECTION FORM <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine ManacLer <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan ~ 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 ® 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 ~ 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 />Z ~ <br />' <br /> <br />15. <br />Cracks, bulging, or erosion on upsteam face ~ <br />Yes . <br />~ <br />~ Feet <br />N/A <br />16. Visible sumps or sinkholes in slurry surface Yes I~i 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/A <br /> b) Decant system Yes ® N/A <br />19. Trash racks clear and in place © No N/A <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : ~~, ~S G, Y+. Date : 7~ ~~,~ p-1 <br />NPDES ID. No.:CO-0000213 Date Last Inspected: 'Lo o'l <br />Facility Configuration:Incised Pond <br />Site Name: Impoundment #012 Location:47N16W Sec 36 <br />Mine Name: New Horizon Mine Location:2_mi.NW of Nucla. CO. <br />~~ Ps n~ L..1 4$ G~4a~ne~ ~~ Sad • M.q/~-~ ~ ~'4 ~ ~1 <br />8 R-~ c. G O ~ l.~ q-~...r • h ~ov~u tiv. <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br /> <br />