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<br />KKv ? <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Date: -6 'V,- ?, -z-,j %c) <br />NPDES ID. No.:CO-0000213 Date Last Inspected: l1-13 Facility Configuration:Incised Pond <br />Site Name: Impoundment #012 Location:47N16W 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) ® No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan CZjj? No N/A <br />4. Burning (specify extend and location) Yes (0;? N/A <br />S. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdrain pipes: Yes QE?> N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes CEZ;L N/A <br /> d) Over widespread areas Yes <11D N/A <br /> e) From downsteam foundation area Yes dE N/A <br /> f) "Boils" beneath stram or ponded water Yes CIM, N/A <br />7. Cracks or scarps on crest Yes (M> N/A <br />8. Cracks or scraps on slope Yes C3ED1 N/A <br />9. Sloughing or bulging on slope Yes (Mo N/A <br />10. Major erosion problems Yes qz5!0 N/A <br />11. Surface movements in valley bottom or on hillside Yes (Z> N/A <br />12. Erosion of toe Yes (o N/A <br />13. Water impounded against toe Yes N/A <br />14. Existing embankment freeboard (feet) S&c,0j , 3- !560( ? 8 U Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes <95, N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes (:N?O N/A <br /> b) Decant system Yes CIS N/A <br /> C) Diversion Ditches Yes N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes N/A <br /> b) Decant system Yes C Y N/A <br />19. Trash racks clear and in place Ye <br />1-11 No N/A <br />--Pd n ? ) S Nn ,4 ?)) -5 C-two f S 1 f, V, - <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />Zs? <br />17q,4 (r- C,91