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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name :A?,;t? Date: <br />NPDES ID. No.:CO-0000213 Date Last Inspected: p?` O <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #0013 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) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan 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 /> a.) From underdrain pipes: Yes (Eq N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes ?o N/A <br /> d) over widespread areas Yes d 9 <br />T?) N/A <br /> e) From downsteam foundation area Yes _ <br />CE5D N/A <br /> f) "Boils" beneath stram or ponded water Yes (:13? 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 <IV? N/A <br />10. Major erosion problems Yes Cp N/A <br />11. Surface movements in valley bottom or on hillside Yes Cfa N/A <br />12. Erosion of toe Yes (zk N/A <br />13. Water impounded against toe Yes No N/A <br />14. Existing embankment freeboard (feet) 10 , ' Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ( N/A <br />16. visible sumps or sinkholes in slurry surface Yes (ip N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes OY N/A <br /> b) Decant system Yes (0 N/A <br /> c) Diversion Ditches Yes an-0 N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ® N/A <br /> b) Decant system Yes ® N/A <br />19. Trash racks clear and in place Ye No N/A <br />5 rid} ?SC?..aY?iwc? POO J+ G/ST <br /> ? <br />S <br />VS <br />C <br /> C) <br />U9?o <br /> 'a <br /> <br />2 <br />D <br />F:\Eng \DATA\WP\pond-banks\DAMFORM.wpd ..... ..,??(??