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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : ? ?"A Date: (o l to k ZCog <br />NPDES ID. No.:CO-0000213 Date Last Inspected: 3A1-z,`zrcM& <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) Ye No N/A <br />2. 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 No N/A <br /> b.) At isolated points on embankment slopes: Yes 0 N/A <br /> c) At natural hillside: Yes o N/A <br /> d) Over widespread areas Yes No N/A <br /> e) From downsteam foundation area Yes o N/A <br /> f) "Boils" beneath stram or ponded water Yes <br />7RO <br /> <br />N/A <br />7. Cracks or scarps on crest Yes o N/A <br />8. Cracks or scraps on slope Yes N/A <br />9. Sloughing or bulging on slope Yes No N/A <br />10. Major erosion problems Yes No N/A <br />11. Surface movements in valley bottom or on hillside Yes o N/A <br />12. Erosion of toe Yes N/A <br />13. Water impounded against toe Yes- No N/A <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 Ny, N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes No N/A <br /> b) Decant system Yes No N/A <br /> c) Diversion Ditches Yes No N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes No N/A <br /> b) Decant system Yes No N/A <br />19. Trash racks clear and in place Yes No N/A <br />?0 tau 7 ??'? ?Oaa4,,? U <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />/' <br />50 <br />`s`S?lNAL <br />1,