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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />P", , o\ <br />Inspectors Name : J?n_?? mss, v?b Date: ABC 2.c? t e <br />NPDES ID. No.:CO-0000213 Date Last Inspected: $ 7,,y <br />Lift thickness (inches) <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location:47N16W SEC 36 <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. <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 />Compaction according to approved plan No <br />Burning (specify extend and location) Yes (9 <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 (TP <br />c) At natural hillside: Yes <br />d) Over widespread areas Yes <br />e) From downsteam foundation area Yes (iP <br />f) "Boils" beneath strain or ponded water Yes <br />Cracks or scarps on crest Yes <br />Cracks or scraps on slope Yes lip <br />Sloughing or bulging on slope Yes 0 <br />Major erosion problems Yes 0 <br />Surface movements in valley bottom or on hillside Yes Nc <br />Erosion of toe Yes <br />Water impounded against toe Yes <br />Existing embankment freeboard (feet) SG ? - le . S <br />Cracks, bulging, or erosion on upsteam face Yes ?NyZ <br />Visible sumps or sinkholes in slurry surface Yes <br />Clogging <br />a) Spillway channels and pipes Yes <br />b) Decant system Yes <br />c) Diversion Ditches Yes <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes N <br />b) Decant system Yes <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 />Trash racks cleat and in place <br />1.5 D <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />N/A <br />N/A <br />