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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors NameT - � _ Date: � �. j �, 07 <br />NPDES ID. No.: 0000213 Date Last Inspected: .Z,O <br />Facility Configuration: Pond <br />Site Name: Impoundment #012 Location: 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) N/A <br />2• Lift thi k <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 />c ness (inches) <br />Compaction according to approved plan <br />Burning (specify extend and location) <br />e <br />No <br />N/A <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />Yes <br />(TP <br />N/A <br />Seepage (specify location, color, and approx. volume) <br />a•) From underdrain pipes: <br />Yes <br />N/A <br />b•) At isolated points on embankment slopes: <br />c) At natural hillside: <br />Yes <br />N/A <br />d) Over widespread areas <br />Yes <br />N/A <br />e) From downsteam foundation area <br />Yes <br />�No1 <br />N/A <br />f) "Boils" beneath stram or ponded water <br />Yes <br />N/A <br />Cracks or scarps on crest <br />Yes <br />N/A <br />Cracks or scraps on slope <br />Yes <br />N/A <br />Sloughing or bulging on slope <br />Yes <br />Yes <br />N/A <br />Major erosion problems <br />�Te' <br />N/A <br />Surface movements in valley bottom or on hillside <br />Yes <br />N/A <br />Erosion of toe <br />Yes <br />N/A <br />Water impounded against toe <br />Yes <br />Yes <br />N/A <br />Existing embankment freeboard (feet) - 2. <br />2 - 7 -. <br />9.(a <br />N/A <br />1 `1 ,1 <br />Cracks, bulging, or erosion on upsteam face <br />Feet <br />Visible sumps or sinkholes in slurry surface <br />Yes <br />N/A <br />Clogging <br />Yes <br />tl�) <br />N/A <br />a) Spillway channels and pipes <br />Yes <br />b) Decant system <br />N/A <br />c) Diversion Ditches <br />Yes <br />N/A <br />Cracking or crushing of pipes <br />Yes <br />LVtY <br />N/A <br />a) Spillway pipes <br />b) Decant system <br />Yes <br />N/A <br />Trash racks clear and in place <br />�-�o Yes <br />� <br />1® <br />N/A <br />/Yes <br />No <br />N/A <br />1 pNb- <br />F: \ \DATA \WP \pond - banks \DAMFORM.wpd <br />r.: <br />V� <br />