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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br /> <br />Mine ID No.: CDMG Permit #0008-81 <br />Owne rs Rep.: R. L. Wade Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <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 N/A <br /> b.) At isolated points on embankment slopes: Yes No N/A <br /> C) At natural hillside: Yes ® N/A <br /> d) Over widespread areas Yes (M N/A <br /> e) From downsteam foundation area Yes N/A <br /> <br />7 f) "Boils" beneath stram or ponded water Yes ® N/A <br />. Cracks or scarps on crest <br /> <br />8. <br />Cracks or scraps on slope Yes ® N/A <br /> <br />9. <br />Sloughing or bulging on slope Yes O4.D N/A <br /> <br />10. <br />Major erosion problems Yes ® N/A <br /> <br />11. <br />Surface movements in valley bottom or on hillside Yes ® N/A <br /> <br />12. <br />Erosion of toe Yes (!n N/A <br /> <br />13. <br />Water impounded against toe Yes N/A <br /> <br />14. <br />Existing embankment freeboard (feet) <br />9 <br />Ka <br />of <br />T <br />614 Yes ® N/A <br /> <br /> <br />is. - <br />- <br />. <br />- <br />- <br />, <br />Cracks, bulging, or erosion on upsteam face <br />- <br />Yes <br />Feet <br />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 <br /> <br />16. <br />Cracking or crushing of pipes Yes ® N/A <br /> a) Spillway pipes Yes N/A <br /> b) Decant system Yes lam/ N/A <br />19. Trash racks clear and in place Ye No N/A <br />Date: 1(3 *1uv ZQ%Q <br />Date Last Inspected:la a 7U(C7 <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 />Inspectors Name:-T-),.SS GuA1<t, <br />NPDES ID. No.:CO-0000213 <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />/o r\16 V ??e (