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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Date: (o 1 10 !tee <br />NPDES ID. No.:CO-0000213 Date Last Inspected: ?S IZs? j <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 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 /> <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) Yes 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 o N/A <br /> b.) At isolated points on embankment slopes: Yes o N/A <br /> c) At natural hillside: Yes o 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 N/A <br />8. Cracks or scraps on slope Yes o N/A <br />9. Sloughing or bulging on slope Yes N N/A <br />10. Major erosion problems Yes No N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes N N/A <br />13. Water impounded against toe Yes N/A <br />14. Existing embankment freeboard (feet) Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes o N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N N/A <br />17. Clogging <br /> <br /> a) Spillway channels and pipes Yes N/A <br /> b) Decant system Yes N N/A <br /> c) Diversion Ditches Yes o N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes N N/A <br /> b) Decant system Yes t?!?') N/A <br />19. Trash racks clear and in place es No N/A <br />p0 RE(, js, <br />5n: A <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />I iS`'V,-e- v?!D <br />k