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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Date J aN, to o& <br />NPDES ID. No.:CO-0000213 Date Last Inspected: ML-v- V-> X? <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #0014 Location:47N15W SEC 31 <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) es No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan Yes No N/A <br />4. Burning (specify extend and location) Yes A N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br />r <br />a.) From underdrain pipes: Yes ` N/A <br />b.) At isolated points on embankment slopes: Yes No N/A <br />c) At natural hillside: Yes N N/A <br />d) Over widespread areas Yes 'N N/A <br />e) From downsteam foundation area Yes N N/A <br />f) "Boils" beneath stram or ponded water Yes °No N/A <br />7. Cracks or scarps on crest Yes 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 N/A <br />11. Surface movements in valley bottom or on hillside Yes o N/A <br />12. Erosion of toe Yes N N/A <br />13. Water impounded against toe Yes o 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 No N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes No N/ <br />b) Decant system Yes No N/A <br />c) Diversion Ditches Yes No A <br />18. Cracking or crushing of pipes <br />a) Spillway pipes Yes No <br />b) Decant system Yes No A <br />19. Trash racks clear and in place Yes No N/A <br />' VV S (;srop <br />fo, <br />tAD <br />50 <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd ••..••? <br />S/ONAL