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I <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: At <br />Date: '7400 p <br />NPDES ID. No.:CO-0000213 <br />Date Last Inspected: MILL. ! <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla. CO. <br />Mine ID No.: CDMG Permit1#0008-81 <br />i <br />Owners Rep.: R. L. Wade „ Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br /> <br />1. I <br />Foundation Preparation (removal of vegetation, stumps., topso <br />il) a <br />No <br />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 1tNO1 N/A <br />5. Angle of slope: 3.1 upstream; 3:1 downstream ll!! <br />6. Seepage (specify location, color, and approx. volume) <br /> a.). From underdrain pipes:, Yes N/A <br /> i <br />b.) At isolated <br />oints on <br />mb <br />k <br />t <br />l <br /> p <br />e <br />an <br />men <br />s <br />opes: Yes N/A <br /> c) At natural hillside: Yes o N/A <br /> d) Over widespread areas <br /> Yes N/A <br /> e) From downsteam foundation area <br /> <br />f) "Boils" beneath stram or <br />d <br />d Yes o N/A <br /> pon <br />e <br />water Yes N/A <br />7. Cracks or scarps on crest Yes N N/A <br />8. Cracks or scraps on slope Yes N/A <br /> <br />9. I <br />Sloughing or bulging on slope <br /> . Yes o N/A <br />10. Major erosion problems Yes o 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 N N/A <br />14. Existing embankment freeboardi(feet) <br />I lo. Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N/A <br />16. Visible sumps or sinkholes in'slurry surface Yes N N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes No N/A <br /> b) Decant system Yes N/A <br /> c) Diversion Ditches Yes o N/A <br />18. Cracking or crushing of pipes <br /> I <br />a) Spillway pries <br />Yes <br />N <br />N/A <br /> b) Decant system Yes N N/A <br />19. Trash racks clear and in place s No N/A <br />O EO/ <br />FO o,,.1,V.wls N" <br />n'' ca ?' Ga?';o <br />I ; <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpdi <br />I <br />TONAL <br />I - <br /> <br />