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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : SSVDkQ Date : 8 ??b Zrv t <br />NPDES ID. No.:CO-0000213 Date Last Inspected: <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #011 Location:46N16W SEC 1 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit 40008-81 <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 <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 />16 <br />19. <br />Lift thickness (inches) <br />Compaction according to approved plan &? No <br />Burning (specify extend and location) Yes <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: Yes <br />b.) At isolated points on embankment slopes: Yes FIo <br />c) At natural hillside: Yes <br />d) Over widespread areas Yes 1? <br />e) From downsteam foundation area Yes <br />f) "Boils" beneath stram or ponded water Yes <br />Cracks or scarps on crest Yes <br />Cracks or scraps on slope Yes PT. <br />Sloughing or bulging on slope Yes <br />Major erosion problems Yes <br />Surface movements in valley bottom or on hillside Yes <br />Erosion of toe Yes <br />water impounded against toe Yes <br />Existing embankment freeboard (feet) ?? , ° 5(pltj = 1 317 <br />Cracks, bulging, or erosion on upsteam face Yes <br />Visible sumps or sinkholes in slurry surface Yes <br />Clogging <br />a) Spillway channels and pipes Yes 10) <br />b) Decant system Yes <XD? <br />c) Diversion Ditches Yes (131 <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes NOD) <br />b) Decant system Yes 90 <br />Trash racks clear and in place Ye No <br />?1SG\n4 rc,l s - <br />O r? <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />0