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J <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Date : ~ 3 IY'i c~.r c.Qn O~ <br />Date Last Inspected: ~j ~~~ b-( <br />Facility Configuration: Parcel Incised Pond <br />Inspectors Tfame : ~,d,ss ~~pk,s1 <br />NPDES ID. No.:CO-0000213 <br />Site Name: Impoundment #Oll Location:46N16W SEC 1 <br />Mine Name: Tfew 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 />2. Lift thickness (inches) <br />3. Compaction according to approved plan Yes 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 ~yc 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) q Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N~ N/A <br />16. Visible sumps or sinkholes in slurry surface Yes 7y 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 ~1Q N/A <br /> b) Decant system Yes ® N/A <br />19. Trash racks clear and in place ~A No N/A <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ~ No N/A <br />F:\Eng\DATA\WP\porid-banks\DAMFORM.wpd <br />~3 ry~aac~. 08 <br />