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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Zc Date: to N Uy1 ?c»p <br />NPDE S ID. No.:CO-0000213 Date Last Inspected:10 2aa1C? <br />Faci lity Configuration: Total Incised Pond <br />Site Name: Impoundment #009 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 />Owne rs Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE R ESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) 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 No 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 Qs N/A <br /> b.) At isolated points on embankment slopes: Yes is N/A <br /> c) At natural hillside: Yes ® N/A <br /> d) Over widespread areas Yes IQ N/A <br /> e) From downsteam foundation area Yes ?Q 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 <br /> <br />11. <br />Surface movements in valley bottom or on hillside Yes <br />Yes ® <br />® N/A <br />N/A <br />12. Erosion of toe <br /> <br />13. <br />Water impounded against toe Yes <br />Yes ? <br />J&--5 N/A <br />N/A <br />14. Existing embankment freeboard (feet)? ZQe / 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 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 t N/A <br /> b) Decant system Yes (T%) N/A <br />19. Trash racks cleat and in place (9 No N/A <br /> <br />?d IJ Go ?-s ? r ©Q F?ECifS,T <br /> ? <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />