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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: low%- <br />Tkv <br />Date: <br />NPDES ID. No.: 0000213 Date Last Inspected: 2. <br />p G 09 <br />Facility Configuration: Cross Valley Pond <br />Site Name: Impoundment #007 Location: SEC 6 <br />Mine Name: New Horizon Mine Location: mi.N_W 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) es No N/A <br />2. Lift thick— <br />F: \ \DATA \WP \pond - banks \DAMFORM.wpd <br />r�, �U-v o�. <br />ess (inches) <br />3. <br />Compaction according to approved plan <br />No <br />N/A <br />4 <br />Burning (specify extend and location) <br />Yes <br />® <br />N /A. <br />5. <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />6. <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: <br />Yes <br />® <br />N/A <br />b.) At isolated points on embankment slopes: <br />Yes <br />N/A <br />c) At natural hillside: <br />d) over widespread areas <br />Yes <br />Yes <br />® <br />N/A <br />N/A <br />e) From downsteam foundation area <br />Yes <br />fflo <br />N/A <br />f) "Boils" beneath strain or ponded water <br />Yes <br />N/A <br />7. <br />Cracks or scarps on crest <br />8. <br />Cracks or scraps on slope <br />Yes <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes <br />Yes <br />N/A <br />10. <br />Major erosion problems <br />Yes <br />1� <br />N /A' <br />N/A <br />11. <br />Surface movements in valley bottom or on hillside <br />Yes <br />a <br />N/A <br />12. <br />Erosion of toe <br />13. <br />Water impounded against toe <br />Yes <br />N/A <br />14. <br />Existing embankment freeboard (feet) 51,44 0 L <br />Yes <br />N/A <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes <br />� <br />Feet <br />N/A <br />16. <br />Visible sumps or sinkholes in slurry surface <br />17. <br />Clogging <br />Yes <br />N/A <br />a) Spillway channels and pipes <br />b) Decant system <br />Yes <br />N/A <br />c) Diversion Ditches <br />Yes <br />Yes <br />t <br />N/A <br />19. <br />Cracking or crushing of pipes <br />N/A <br />a) Spillway pipes <br />Yes <br />N/A <br />b) Decant system <br />Yes <br />N/A <br />19. <br />Trash racks clear and in place <br />qe� <br />No <br />N/A <br />F: \ \DATA \WP \pond - banks \DAMFORM.wpd <br />r�, �U-v o�. <br />