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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name :'Rom G, k Date: lo N o V Zo 0 <br />NPDES ID. No.:CO-0000213 Date Last Inspected: Jp?,uc,A . ZQ(0 <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) No N/A <br />2 <br /> Lift thickness (inches) <br />3. Compaction according to approved plan No N/A <br />4. Burning (specify extend and location) Yes 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 ®o N/A <br />8. <br />9 Cracks or scraps on slope Yes ® N/A <br />. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems <br /> Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe <br /> <br />13. <br />Water impounded against toe Yes ® N/A <br /> <br />14. <br />Existing embankment freeboard (feet)jo Yes <br />s <br />/4 (ZD? N/A <br /> <br />is. <br />Cracks, bulging, or erosion on upsteam face - <br />Yes G 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 Y <br /> <br />C) Diversion Ditches es <br />Y N/A <br /> <br />1s. <br />Cracking or crushing of pipes es N/A <br /> a) Spillway pipes Yes (92 N/A <br /> b) Decant system Ye Q <br /> <br />19. <br />Trash racks clear and in place s <br /> <br />2 N/A <br /> s <br />d No N/A <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />