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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : Esc ?,1La Date: F-Q \,r, iol\ <br />NPDES ID. No.:CO-0000213 Date Last Inspected: IOtw??U 21,0 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment 4008 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.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) (?D 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 />is. <br />16. <br />17. <br />18 <br />19 <br /> <br />Lift thickness (inches) <br />Compaction according to approved plan elD No N/A <br />Burning (specify extend and location) Yes <ZD N/A <br />Angle of slope: 3.1 upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: Yes (V N/A <br />b.) At isolated points on embankment slopes: Yes xc? 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 (M N/A <br />f) "Boils" beneath stram or ponded water Yes (!!I- <br />N/A <br />Cracks or scarps on crest Yes N/A <br />Cracks or scraps on slope Yes N/A <br />Sloughing or bulging on slope Yes N/A <br />Major erosion problems Yes Q N/A <br />Surface movements in valley bottom or on hillside Yes (S N/A <br />Erosion of toe Yes (8? N/A <br />Water impounded against toe Yes ®o N/A <br />Existing embankment freeboard (feet)?(o? _4'9i dt 8? Feet <br />Cracks, bulging, or erosion on upsteam face _ <br />Yes _ N/A <br />Visible sumps or sinkholes in slurry surface Yes 40d N/A <br />Clogging <br />a) Spillway channels and pipes Yes TP N/A <br />b) Decant system Yes ® N/A <br />c) Diversion Ditches Yes N/A <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes N/A <br />b) Decant system Yes (<3? N/A <br />Trash racks clear and in place Yes. No N/A <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />C? Co \