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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name ?OkA Date: pZ. G p Q? <br />NPDES ID. No.:CO-0000213 Date Last Inspected : OF <br />Facil ity 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) No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan Ye 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 N/A <br /> b.) At isolated points on embankment slopes: Yes (gP N/A <br /> c) At natural hillside: Yes 0 N/A <br /> d) Over widespread areas Yes <10 N/A <br /> e) From downsteam foundation area Yes 10 N/A <br /> f) "Boils" beneath straw or ponded water Yes (gD N/A <br />7. Cracks or scarps on crest Yes djZ-p) N/A <br />8. Cracks or scraps on slope Yes ® N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes ® N/A <br />11. Surface movements in valley bottom or on hillside Yes (j-P N/A <br />12. Erosion of toe Yes (1 N/A <br />13. Water impounded against toe Yes (Ve N/A <br />14. Existing embankment freeboard (feet) <br />?'?,3 <br />9.1 <br />Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes (D N/A <br /> b) Decant system Yes N® N/A <br /> c) Diversion Ditches Yes Cmy N/A <br />is. Cracking or crushing of pipes <br /> a) Spillway pipes Yes (G> N/A <br /> b) Decant system Yes (-o N/A <br />19. Trash racks clear and in place (9s No N/A <br />?n ? a , S ?• d? D , sc.Lw r?? <br />b? <br />-90A <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd