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<br />w <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name :~s~; G~,~~~ Date : 131~gYC~,~ p $ <br />NPDES ID. No.:CO-0000213 Date La st Inspected : Zn n~~~p"~ <br />Facility Configuration: 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 />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. Lift thickness (inches) <br />3. Compaction according to approved plan Q No N/A <br />4. Burning (specify extend and location) Yes ~ N/A <br />5. Angle of s:Lope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) Frcm underdrain pipes: Yes ~ N/A <br /> b.) At isolated points on embankment slopes: Yes Icy N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yes ~7 N/A <br /> e) Frcm downsteam foundation area Yes ® . N/A <br /> f) "Boils" beneath stram or ponded water Yes ~ N/A <br />7. Cracks or :;carps 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 /> ~ <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/A <br /> b) Decant system Yes @ N/A <br />19. Trash racks clear and in place Ye No N/A <br />~ADino~ \S ~~SrJV10~~~~~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />/3 .M cat rcpt:. O 8 <br />