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PERIODIC INSPECTION FORM <br />. WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : Date: 10 'zsz) <br />NPDES ID. No.:CO-0000213 Date Last Inspected: -MAY ZO?O <br />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) (a 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 (ZD N/A <br /> c) At natural hillside: Yes ?7 N/A <br /> d) Over widespread areas Yes ® N/A <br /> e) From downsteam foundation area Yes ® N/A <br /> f) "Boils" beneath stram or ponded water Yes N/A <br />7. Cracks or scarps on crest Yes N/A <br />8. 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 40 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) 5( <br />0- <br />3 -559 AZ 9 <br /> .. <br />7 .1 Feet <br />15. 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 40 N/A <br /> b) Decant system Yes (3 N/A <br /> c) Diversion Ditches Yes Q N/A <br />is. Cracking or crushing of pipes <br /> a) Spillway pipes Yes N/A <br /> b) Decant system Yes 1Q? N/A <br />19. Trash racks clear and in place Yes No N/A <br />-!5rv.,,o LL moo` 04 wcr?-wr r "n bDWV w?, <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />