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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : 1R0_<5 GKIJ `t Date: L? yy A-, ( zgot n <br />NPDES ID. NO.:CO-0000213 Date Last Inspected: 00 F.?a Zjt-(13 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l 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 No N/A <br />4. Burning (specify extend and location) Yes 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 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 0D, N/A <br /> f) "Boils" beneath stram or ponded water Yes ®, N/A <br />7. Cracks or scarps on crest Yes (291 N/A <br />8. Cracks or scraps on slope Yes ® N/A <br />9. Sloughing or bulging on slope Yes (M N/A <br />10. Major erosion problems Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes fib N/A <br />13. Water impounded against toe Yes (:M5 N/A <br />14. Existing embankment freeboard (feet)_?[_.Sg.3--? 4-1 /0. 70 Feet <br />is. Cracks, bulging, or erosion on upsteam face Yes ? 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/A <br /> b) Decant system Yes 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 N/A <br />19. Trash racks clear and in place Ye No N/A <br />O"G 1$ n A S GV? GL9 ln,?, <br />RQ <br />NHS <br />v IQ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd ,,`• <br />`?I?N01_rG? <br />*?Ayl Z-0 I Z)