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<br /> <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name Date: Oct S, ON 0% <br />NPDES ID. No.:CO-0000213 Date Last Inspected: p 08 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location:47N16W SEC 36 <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) Z No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan <br /> <br />4. <br />Burning (specify extend and location) <br />Yes No N/A <br />N/A <br />S. Angle of slope: 3:1 upstream, 3:1 downstream ?S+ <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdrain pipes: Yes ® N/A <br /> b.) At isolated points on embankment slopes: Yes Q N/A <br /> c) At natural hillside: <br /> <br />d) Over widespread areas Yes <br />Yes ® <br />QD N/A <br />N/A <br /> e) From downsteam foundation area <br /> <br />f) "Boils" beneath stram or ponded water Yes N/A <br /> <br />7. <br />Cracks or scarps on crest Yes <br />Yes <br />1 N/A <br />N/A <br />8. Cracks or scraps on slope Yes N? N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems <br /> <br /> <br />11. <br /> <br />Surface movements in valley bottom or on hillside Yes <br /> <br /> <br />Yes <br /> <br />® <br />N/A <br /> <br />N/A <br />12. Erosion of toe <br /> <br />13. <br />Water impounded against toe Yes Q N/A <br /> <br />14. <br />Existing embankment freeboard (feet) Yes ?+ N/A <br /> <br />is. <br />Cracks, bulging, or erosion on upsteam face <br />Yes Feet <br />N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes ® N/A <br /> b) Decant system Yes N/A <br /> c) Diversion Ditches ? <br /> <br />18. <br />Cracking or crushing of pipes Yes N/A <br /> a) Spillway pipes Yes N/A <br /> b) Decant system Yes ® N/A <br />19. Trash racks cleat and in place <br /> Ye No N/A <br />p ?5 ?r <br />p0 REG/s <br />0???,?W iS G'G <br />pp; <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd v i <br />