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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : Ss <br />NPDES ID. No.:CO-0000213 <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) ®s 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 (Zb 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 (TDO N/A <br /> b.) At isolated points on embankment slopes: Yes IN-) N/A <br /> c) At natural hillside: Yes (!q N/A <br /> d) Over widespread areas Yes <5P 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 N/A <br />8. Cracks or scraps on slope Yes AQ? N/A <br />9. Sloughing or bulging on slope Yes 9 N/A <br />10. Major erosion problems Yes ® N/A <br />11. Surface movements in valley bottom or on hillside Yes (0 N/A <br />12. Erosion of toe Yes (23P N/A <br />13. Water impounded against toe Yes r o N/A <br />14. Existing embankment freeboard (feet) 5&fal 3 - 5.59 8 3 q, 0 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes <0 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 Yes <M? N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ® N/A <br /> b) Decant system Yes I& N/A <br />19. Trash racks clear and in place (IR. No N/A <br />Date: z..S 110 \ 1 <br />Date Last Inspected: \ 0 1V ojy -W kC) <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 /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />I ry,A (.Zv\,. -z-,0 k\