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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : ,S Date: <br />NPDES ID. No.:CO-0000213 Date Last Inspected: 63rn.??c?,o°? <br />Faci lity Configuration: Parcel Incised Pond <br />Site Name: Impoundment #0013 Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:1 mi.NW of Nucla CO <br />Mine ID No.: CDMG Permit #0008-81 <br />Owne rs 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 No 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 TI) 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 (ID N/A <br /> f) "Boils" beneath stram or ponded water <br /> <br />7. <br />Cracks or scarps on crest Yes (ED N/A <br /> <br />8. <br />Cracks or scraps on slope Yes (1P N/A <br /> <br />9. <br />Sloughing or bulging on slope Yes (0> N/A <br /> <br />10. <br />Major erosion problems Yes N/A <br /> <br />11. <br />Surface movements in valley bottom or on hillside Yes ® N/A <br /> <br />12. <br />Erosion of toe Yes n?gq N/A <br /> <br />13. <br />Water impounded against toe Yes Q> N/A <br /> <br />14. <br />Existing embankment freeboard (feet) Yes <br />13 QD <br />5 N/A <br />Feet <br />is. Cracks, bulging, or erosion on upsteam face <br />Yes . <br />N/A <br />16. visible sumps or sinkholes in slurry surface Yes N/A <br />17. Clogging <br /> a) Spillway channels and pipes <br /> <br />b) Decant system Yes <br />Y <br />? N/A <br /> <br />c) Diversion Ditches es i N/A <br /> <br />18. <br />Cracking or crushing of pipes Yes N/A <br /> a) Spillway pipes Yes N/A <br /> b) Decant system <br />Yes <br />N/A <br />19. Trash racks clear and in place ? <br /> 9 No No N/A <br />w t , `, 0;) <br />F:\Eng\DATA\Wp\pond-banks\DAMFORM.wpd <br />fi?'?W?s GG; 9c?` <br />q` <br />? <br />?KA-