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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : -? s G,ZQ Date: NPDES ID. No.:CO-0000213 Date Last Inspected: o Z, <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:46N15W SEC 6 <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) (jil No N/A <br />2 <br /> Lift thickness (inches) <br />3. Compaction according to approved plan 4:1? 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 G N/A <br /> b.) At isolated points on embankment slopes: Yes 1g) 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?o 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 <br /> <br />11. <br />Surface movements in valley bottom or on hillside Yes <br />Yes N/A <br />N/A <br />12. Erosion of toe <br /> <br />13. <br />Water impounded against toe Yes ITP-) N/A <br /> <br />14. <br />Existing embankment freeboard (feet) <br />3 ' S <br />51pSg <br />?- Yes (5? <br />241 <br />?f N/A <br />15. _ <br />? <br />j s? • <br />Cracks, bulging, or erosion on upsteam face Yes Feet <br />N/A <br />16. visible sumps or sinkholes in slurry surface Yes N N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes N N/A <br /> b) Decant system Yes (0 N/A <br /> c) Diversion Ditches Yes ® N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes (:Mw N/A <br /> b) Decant system Yes (M$- N/A <br />19. Trash racks clear and in place <br /> Ye No N/A <br /> <br />i av.. <br />r. . ?"o ,o <br />3 C "J <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />5 ?NAL