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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name NPDES ID. No.:CO-0000213 <br />Date: )D 7ua1 O <br />Date Last Inspected: A-mA?rzp-lo <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 #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) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan 40a 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 NO N/A <br /> b.) At isolated points on embankment slopes: Yes dl?l N/A <br /> c) At natural hillside: Yes QF> N/A <br /> d) Over widespread areas Yes (MR N/A <br /> e) From downsteam foundation area Yes (2)• N/A <br /> f) "Boils" beneath stram or ponded water Yes ® N/A <br />7. Cracks or scarps on crest Yes (M N/A <br />8. Cracks or scraps on slope Yes Ca N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes (30 N/A <br />11. Surface movements in valley bottom or on hillside Yes (21 N/A <br />12. Erosion of toe Yes Qr.J? N/A <br />13. Water impounded against toe Yes N/A <br />14. CC <br />Existing embankment freeboard (feet) U(sZZ. C7 ^ 5?n?? 9. Z Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes (ZED N/A <br />16. Visible sumps or sinkholes in slurry surface Yes qZ!,, 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 />?ph? t5 ?i$CN.or I n% <br />A h Pot a ? ern-o,r%enrr? Se,1? Rio Q? ?- <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />