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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name <br />NPDES ID. No.:CO-0000213 <br />Date: O-LD. 018 <br />Date Last Inspected:,%? <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #011 Location:46N16W SEC 1 <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) C? 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 No 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 N/A <br /> c) At natural hillside: Yes N/A <br /> d) Over widespread areas Yes N/A <br /> e) From downsteam foundation area Yes ® N/A <br /> f) "Boils" beneath stram or ponded water Yes ® N/A <br />7. Cracks or scarps on crest Yes ® N/A <br />8. Cracks or scraps on slope Yes (?D 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 ® N/A <br />12. Erosion of toe Yes N/A <br />13. Water impounded against toe Yes Nc? <br />K N/A <br />14. Existing embankment freeboard (feet)?(1 [s, S Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes (Q> N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes 0r) N/A <br /> b) Decant system Yes (0 N/A <br /> c) Diversion Ditches Yes W N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes (3W N/A <br /> b) Decant system Yes (so N/A <br />19. Trash racks clear and in place Ye No N/A <br />21D <br />3? <br /> <br />1? » a ) 5 c? ? 5 c X <br />roA cow. p Clams V a1 vim, ?v <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />?11? ? S SW'e <br />. <br />we? <br />.f