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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : amass G??bk g Date: Z ; -a b -L4 ; <br />NPDES ID. No.:CO-0000213 Date Last Inspected : ?? i?lt1V z.wa <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009. Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:1 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 R ESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., tops oil) < De No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan fYe--r;) No N/A <br />4. Burning (specify extend and location) Yes 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 4, N/A <br /> b.) At isolated points on embankment slopes: Yes 9D N/A <br /> c) At natural hillside: Yes 90 N/A <br /> d) Over widespread areas Yes I) N/A <br /> e) From downsteam foundation area Yes I(@ N/A <br /> f) "Boils" beneath stram or ponded water Yes Ei 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 N/A <br />10. Major erosion problems Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes 0 N/A <br />13. Water impounded against toe Yes N/A <br />14. Existing embankment freeboard (feet) 4rg Q%- 9(.39 j Q o S Feet <br />15. . <br />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 ®1 N/A <br /> b) Decant system Yes ® N/A <br /> c) Diversion Ditches Yes 1o N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes Do N/A <br /> b) Decant system Yes Q N/A <br />19. Trash racks cleat and in place P No N/A <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />1 .n'V>CL? ?A