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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name :? <br />NPDES ID. No.:CO-0000213 <br />Date: 0 1yy J Zb % Q _ .._,.._._ <br />Date Last Inspected:IO Z,o?o <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:lmi.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 RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) es 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 (e> N/A <br />S. 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 ® N/A <br /> f) "Boils" beneath stram or ponded water Yes N/A <br />7. Cracks or scarps on crest Yes qM N/A <br />8. Cracks or scraps on slope Yes CD N/A <br />9. Sloughing or bulging on slope Yes 4D N/A <br />10. Major erosion problems Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes OUP N/A <br />13. Water impounded against toe Yes ® N/A <br />14. Existing embankment freeboard (feet) SG 3 ?/3 <br />, -7,0 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes gp N/A <br />16. visible sumps or sinkholes in slurry surface Yes (gD? 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 Q, N/A <br /> b) Decant system Yes i1a N/A <br />19. Trash racks clear and in place No N/A <br />/dr d ?S ?e f? -i' If C-4Yq r h <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />/0 fq,)-j -zo 1-0