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I <br />? <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />I <br />I <br />Inspectors Name : 1, ?. Date :-fit--V... 101 Z peo <br />NPDES ID. No.:CO-0000213 Date Last Inspected: ?AL4. Z-00 <br />3 <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #Oll Location:46N16W SEC 1 <br />Mine Name: New Horizon Mine Location:) 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) Yes No <br />2. Lift thickness (inches). <br />3. Compaction according to approved plan N <br />o <br />4. Burning (specify extend and location) Yes No <br />X10/ <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 <br /> b.) At isolated points on embankment slopes: Yes <br /> c) At natural hillside: Yes <br /> d) Over widespread areas; Yes N <br /> e) From downsteam foundation area Yes N <br /> <br /> f) "Boils" beneath stram!or ponded water Yes o <br />7. Cracks or scarps on crest Yes No <br />8. Cracks or scraps on slope i Yes o <br />9. Sloughing or bulging on slope! Yes o <br />10. Major erosion problems Yes <br />11. Surface movements in valley bottom or on hillside Yes <br />12. Erosion of toe Yes <br />13. Water impounded against toe Yes o <br />14. Existing embankment freeboard! (feet) <br />15. Cracks, bulging, or erosion on upsteam face Yes rffn_J <br />16. Visible sumps or sinkholes in slurry surface <br />I Yes `N <br />17. Clogging <br />a) Spillway channels andlpipes Yes N <br />b) Decant system Yes N <br />c) Diversion Ditches Yes <br />18. Cracking or crushing of pipes) <br />a) Spillway pipes Yes Po <br />b) Decant system Yes 19. Trash racks clear and in place es' No <br />?)0 REGI <br />?o? iti bah I'c`' _? wig F <br />A.4,,. a. <br />I <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />NAI.EN <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br /> <br />