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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name :-Ross ??kc Date: a31ngfzCA, C3 1? <br />NPDES ID. No.:CO-0000213 Date Last Inspected: OZ 0 <br />Facility 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) _Ye No N/A <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />11. <br />12. <br />13. <br />14. <br />15. <br />16. <br />17. <br />18. <br />19. <br />-,po r ? <br />Lift thickness (inches) <br />Compaction according to approved plan No <br />Burning (specify extend and location) Yes C3 <br />Angle of slope: 3.1 upstream, 3:1 downstream <br />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 stram or ponded water Yes (T-5p <br />Cracks or scarps on crest Yes <br />Cracks or scraps on slope Yes may' <br />Sloughing or bulging on slope Yes <br />Major erosion problems Yes (INP <br />Surface movements in valley bottom or on hillside Yes (3D) <br />Erosion of toe <br /> Yes (Sm <br />Water impounded against toe <br /> <br />Existing embankment freeboard (feet)_ 560`7,3 Yes ao; <br />-( <br />Cracks, bulging, or erosion on upsteam face Yes N? <br />Visible sumps or sinkholes in slurry surface Yes <br />Clogging <br />a) Spillway channels and pipes Yes I& <br />b) Decant system Yes Uhl <br />c) Diversion Ditches Yes <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes <br />b) Decant system Yes <br />Trash racks clear and in place <br /> Ye No <br />5 140-7 D VSc.G•av J%n <br />F:\Eng\DATA\Wp\pond-banks\DAMFORM.wpd <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 />O? <br />r'n CAIr <br />?3