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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : Date: bZ <br />NPDES ID. No.:CO-0000213 Date Last Inspected: 03I`?,,orc?, oC\' <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) Yes 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 />Lift thickness (inches) <br />Compaction according to approved plan <br />Burning (specify extend and location) <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: <br />b.) At isolated points on embankment slopes: <br />C) At natural hillside: <br />d) Over widespread areas <br />e) From downsteam foundation area <br />f) "Boils" beneath stram or ponded water <br />Cracks or scarps on crest <br />Cracks or scraps on slope <br />Sloughing or bulging on slope <br />major erosion problems <br />Surface movements in valley bottom or on hillside_ <br />Erosion of toe <br />Water impounded against toe <br />Existing embankment freeboard (feet) <br />Cracks, bulging, or erosion on upsteam face <br />visible sumps or sinkholes in slurry surface <br />Clogging <br />a) Spillway channels and pipes <br />b) Decant system <br />c) Diversion Ditches <br />Cracking or crushing of pipes <br />a) Spillway pipes <br />b) Decant system <br />Trash racks clear and in place <br />d -s;, ` ? -C J- 1 Y YOU 1 ` V 1? <br />?Y t CJ-- V- <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />Ye No N/A <br />Yes No N/A <br />Yes No N/A <br />Yes (J?D N/A <br />Yes (1p N/A <br />Yes N/A <br />Yes N/A <br />Yes ® N/A <br />Yes ® N/A <br />Yes N/A <br />Yes N/A <br />Yes ® N/A <br />Yes N/A <br />Yes (MD N/A <br />Yes N/A <br />In Feet <br />Yes N/A <br />Yes Iq N/A <br />Yes ® N/A <br />Yes N/A <br />Yes N/A <br />Yes <br />Yes <br />Ye <br />NQ N/A <br />® N/A <br />No N/A <br />9, POO REG/s - <br />0 wIs " <br />? py c?;o <br />CD <br />b Z Sv rrZ <br />0