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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : I.ss G-0 5x, Date: p tin,, Z,p IO <br />NPDES ID. No.:CO-0000213 Date Last Inspected: b Zc,(Q <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) Ye No N/A <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />18 <br />19 <br /> <br />Lift thickness (inches) <br />Compaction according to approved plan Ye No <br />Burning (specify extend and location) Yes do <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: Yes <br />b.) At isolated points on embankment slopes: Yes <br />c) At natural hillside: Yes <br />d) Over widespread areas Yes <br />e) From downsteam foundation area Yes <br />f) "Boils" beneath stram or ponded water Yes QD <br />Cracks or scarps on crest Yes 4a <br />Cracks or scraps on slope Yes <br />Sloughing or bulging on slope Yes <br />Major erosion problems Yes <br />Surface movements in valley bottom or on hillside Yes <br />Erosion of toe Yes <br />Water impounded against toe Yes <br />Existing embankment freeboard (feet)_ <br />Cracks, bulging, or erosion on upsteam face Yes <br />Visible sumps or sinkholes in slurry surface Yes <br />Clogging <br />a) Spillway channels and pipes Yes <br />b) Decant system Yes <br />c) Diversion Ditches Yes <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes <br />b) Decant system Yes ?? <br />Trash racks clear and in place ® No <br />?o^N? 1." 64600, <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 />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 <br />) 0 NC) X/ '2'4'