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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : 1,6-' &A, \<R <br />NPDES ID. No.:CO-0000213 <br />Date: 03 mcyY coq <br />Date Last Inspected: aZ zex ck, <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) Ye 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 do N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes (!I?> N/A <br /> d) Over widespread areas Yes (M N/A <br /> e) From downsteam foundation area Yes qzD N/A <br /> f) "Boils" beneath strain or ponded water Yes 1P) N/A <br />7. Cracks or scarps on crest Yes to? 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 TH) N/A <br />12. Erosion of toe Yes ® N/A <br />13. Water impounded against toe Yes (RO N/A <br />14. Existing embankment freeboard (feet) Sc" L?,?a - S11 Z Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N/A <br />16. Visible sumps or sinkholes in slurry surface YesJ N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes QD N/A <br /> b) Decant system Yes ® N/A <br /> c) Diversion Ditches Yes ® 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 a No N/A <br /> N vG/,S? <br />P00 <br /> OQ' <br />1 <br /> <br /> <br /> U: ? a <br />O <br /> <br />F <br />\E <br />: <br />ng \DATA\WP\pond-banks\DAMFORM.wpd <br />?SS?ONAL