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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : Galy Date • ?,Ao..XA- ?O , Sao ea <br />NPDES ID. No.:CO-0000213 Date Last Inspected: t "e o& <br />Facility Configuration:Incised Pond <br />Site Name: Impoundment #012 Location:47N16W Sec 36 <br />Mine Name: New Horizon Mine Location:2 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) 6P No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan e 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 />7. <br />8. <br />9. <br />10. <br />11. <br />12. <br />13. <br />14. <br />15. <br />16. <br />17. <br />18 <br />19 <br />a.) From underdrain pipes: Yes No <br />b.) At isolated points on embankment slopes: Yes o <br />c) At natural hillside: Yes <br />d) Over widespread areas Yes <br />e) From downsteam foundation area Yes o <br />f) "Boils" beneath stram or ponded water Yes VD. <br />Cracks or scarps on crest Yes No <br />Cracks or scraps on slope Yes No <br />Sloughing or bulging on slope Yes <br />Major erosion problems Yes o <br />Surface movements in valley bottom or on hillside Yes <br />Erosion of toe Yes <br />Water impounded against toe Yes o <br />Existing embankment freeboard (feet) <br /> <br />i <br />Cracks, bul9ng, or erosion on upsteam face Yes no <br />visible sumps or sinkholes in slurry surface Yes o <br />Clogging <br />a) Spillway channels and pipes Yes <br />b) Decant system Yes o <br />c) Diversion Ditches Yes 'air 1 <br />t <br />/ <br />Cracking or crushing of pipes om' <br />a) Spillway pipes Yes o <br />b) Decant system Yes o <br />Trash racks clear and in place es No <br /> <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 />J 1 ? ?- ?v <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />