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<br />W <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name Date: ©Ol ,d$ <br />NPDES ID. NO.:CO-0000213 Date Last Inspected: IOU),, C-A <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) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan <br /> <br />4. <br />Burning (specify extend and location) Ye <br />Yes No N/A <br />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: <br />Yes <br />? <br />N/A <br /> b•) At isolated points on embankment slopes: Yes N? N/A <br /> c) At natural hillside: Yes N/A <br /> d) Over widespread areas Yes ® N/A <br /> e) From downsteam foundation area <br />Yes <br />? <br />N/A <br /> f) "Boils" beneath strain or ponded water Yes ® N/A <br />7. Cracks or scarps on crest <br />Yes <br />® <br />N/A <br />8• <br /> <br />9 Cracks or scraps on slope <br />Yes <br />N/A <br />. Sloughing or bulging on slope <br /> <br />10. <br />Major erosion problems Yes N/A <br /> <br />11. <br /> <br />1 <br />Surface movements in valley bottom or on hillside Yes <br /> <br />Yes ® N/A <br /> <br />N/A <br />2. Erosion of toe <br /> <br />13. <br />Water impounded against toe Yes QD, N/A <br /> <br />14. Q <br />Existing embankment freeboard (feet) S(nQcj •• SS <br />A Yes <br />?/ M N/A <br /> <br />15. 1 <br />Cracks, bulging, or erosion on upsteam face -{1?J. <br /> <br />Yes J-- <br /> <br />® Feet <br /> <br />N/A <br />16. Visible sumps or sinkholes in slurry surface <br /> <br />17. <br />Clogging Yes N/A <br /> a) Spillway channels and,pipes Yes N/A <br /> b) Decant system Yes N/A <br /> c) Diversion Ditches <br />Yes <br />® <br />N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ® N/A <br /> <br />1 b) Decant system Yes No N/A <br />9. Trash racks clear and in place <br /> ? No N/A <br />1 _11 <br />In LS "G <br />r <br /> Y <br />A yt-& <br />Op REG/'S' <br />U .h sci i <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />OOl ?-\ (356