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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : i?,zsS Date: OZ-Su •?.? Co 'I, <br />NPDES ID. No.:CO-0000213 Date Last Inspected: ZS3`M.As?c?,.v? <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment 4011 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 No N/A <br />4. Burning (specify extend and location) Yes Q 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 N/A <br /> b.) At isolated points on embankment slopes: Yes 4=> 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 (I N/A <br /> f) "Boils" beneath stram or ponded water Yes (S;,:;X N/A <br />7. Cracks or scarps on crest Yes ti N/A <br />8. Cracks or scraps on slope Yes o N/A <br />9. Sloughing or bulging on slope Yes N/A <br />10. Major erosion problems Yes 0 N/A <br />11. Surface movements in valley bottom or on hillside Yes FVd N/A <br />12. Erosion of toe Yes N/A <br />13. Water impounded against toe Yes No N/A <br />14. Existing embankment freeboard (feet) A ' Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes _ <br />CIP N/A <br />16. Visible sumps or sinkholes in slurry surface Yes (I N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes (06 N/A <br /> b) Decant system Yes ? N/A <br /> c) Diversion Ditches Yes r 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 No N/A <br />N V% <br />d r <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />?O REG/S, <br />o?SEW IS G'GTFp?, °c? <br />• •o <br />s `?ONAL?