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<br /> <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br /> ope. 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a•) From underdrain pipes: <br /> <br />b•) At isolated points on embankment slopes: Yes <Z6 <br /> <br />c) At natural hillside: Yes QD, <br /> <br />d) Over widespread areas Yes <br /> <br />e) From downsteam foundation area ' Yes <br /> f) "Boils" beneath stram or ponded water Yes N® <br />7. Cracks or scarps on crest Yes <br />g, <br />Cracks or scraps on slope Yes (zo <br />9• Sloughing or bulging on slope Yes <br />10. Major erosion problems Yes <br />11. Surface movements in valley bottom or on hillside Yes M <br />12. Erosion of toe Yes <br />13. Water impounded against toe Yes <br />14. <br />is Existing embankment freeboard (feet) Yes 0 <br />S, <br />. Cracks, bulging, or erosion on upsteam face <br />16. Visible sumps or sinkholes in slurry surface Yes <br />17. Clogging Yes Cif <br /> a) Spillway channels and pipes <br /> <br />b) Decant system Yes <br /> <br />c) Diversion Ditches Yes IZP <br />18. Cracking or crushing of pipes Yes <br /> a) Spillway pipes <br /> <br />b) Decant system Yes <br />19. Trash racks clear and in place Yes No <br /> U No <br />Inspectors Name:]2,- 'ONzh. Date: 1O hu-kAS? Zs?IO <br />NPDES ID. No.:CO-0000213 Date Last Inspected: 46 Pkic t. Z_QK) <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #0013 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) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan <br />4. Burnin No N/A <br />9 (specify extend and location) Yes No N/A <br />5. Angle of sl <br />pool Iy <br />F:\Eng\DATA\WP\pond-banks \DAMFORM.wpd <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 />N/A <br />N/A <br />N/A <br />10 A%.& c-2-0 \D