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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name Date: OZ'De <br />NPDES ID. No.:CO-0000213 Date Last Inspected: <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) Ye No <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan No <br />4. Burning (specify extend and location) Yes lia. <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 <br /> b.) At isolated points on embankment slopes: Yes <br /> c) At natural hillside: Yes <br /> d) over widespread areas Yes <br /> e) From downsteam foundation area Yes <br /> f) "Boils" beneath strain or ponded water Yes 01 <br />7. Cracks or scarps on crest Yes <br />8. Cracks or scraps on slope Yes No <br />9. Sloughing or'bulging on slope Yes <br />10. Major erosion problems Yes <br />11. Surface movements in valley bottom or on hillside Yes <br />12. Erosion of toe Yes Q <br />13. Water impounded against toe Yes No <br />14. Existing embankment freeboard (feet) !;(p p l, <br />g, <br />15. Cracks, bulging, or erosion on upsteam face Yes Q1 <br />16. Visible sumps or sinkholes in slurry surface Yes Q?h <br />17. Clogging <br /> a) Spillway channels and pipes Yes 00 <br /> b) Decant system Yes Q <br /> c) Diversion Ditches Yes L <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes <br /> b) Decant system Yes (PI <br />19. Trash racks cleat and in place G;;) No <br />-Por? ` S -1-:?,C F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br /> <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Z-??oS <br />0