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:1%. <br />0d <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name :?j, ou u\p Date: pq <br />NPDES ID. No.:CO-0000213 Date Last Inspected:)p73pt,? <br />Facility Configuration: Cross Valley Pond <br />Site Name: Impoundment #007 Location:46N15W SEC 6 <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) (5 No N/A <br />2. <br />3. <br />4. <br />5. <br />6. <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 />Lift thickness (inches) <br />Compaction according to approved plan <br />Burning (specify extend and location) <br />Angle of slope: 3.1 upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: <br />b.) At isolated points on embankment slopes: <br />c) At natural hillside: <br />d) over widespread areas <br />e) From downsteam foundation area <br />f) "Boils" beneath stram or ponded water <br />Cracks or scarps on crest <br />Cracks or scraps on slope <br />Sloughing or bulging on slope <br />Major erosion problems <br />Surface movements in valley bottom or on hillside <br />Erosion of toe <br />Water impounded against toe <br />Existing embankment freeboard (feet) <br />Cracks, bulging, or erosion on upsteam face <br />Visible sumps or sinkholes in slurry surface <br />Clogging <br />a) spillway channels and pipes <br />b) Decant system <br />c) Diversion Ditches <br />Cracking or crushing of pipes <br />a) Spillway pipes <br />b) Decant system <br />Trash racks clear and in place <br /> <br />Q9 No N/A <br />Yes N/A. <br />Yes No N/A <br />Yes Q) N/A <br />Yes (D N/A <br />Yes N/A <br />Yes ® N/A <br />Yes ® N/A <br />Yes N/A <br />Yes N/A <br />Yes N/A' <br />Yes [ N/A <br />Yes ® N/A <br />Yes N/A <br />Yes , No N/A <br />- _ Feet <br />Yes N/A <br />Yes Ij N/A <br />Yes ® N/A <br />Yes N/A <br />Yes N/A <br />Yes <br />Yes <br />N/A <br />® N/A <br />No N/A <br /> <br />F:\Eng\DATA\Wp\pond-banks\DAMFORM.wpd <br />