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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />fwd HG' <br />Inspectors Name, -( ,-:q-5 ? Date•_ knw-r t-0 D <br />NPDES ID. No.:CO-0000213 Date Last Inspected: g T::;\ <br />,o Zp(? <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #011 Location:46N16W SEC 1 <br />Mine Name: New Horizon Mine Location:1 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 R ESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., tops oil) 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 do N/A <br />f) "Boils" beneath stram or ponded water Yes I N/A <br />7. Cracks or scarps on crest Yes N/A <br />a. Cracks or scraps on slope Yes N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes C N/A <br />12. Erosion of toe Yes N/A <br />13. Water impounded against toe Yes N/A <br />14. Existing embankment freeboard (feet) Z Z. _ 9_ Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes No 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 ®j N/A <br />c) Diversion Ditches Yes N/A <br />16. Cracking or crushing of pipes <br />a) Spillway pipes Yes N/A <br />b) Decant system Yes No N/A <br />19. Trash <br />acks clear and in place No N/A <br />, r <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />4-?-WA,f 2-0 10