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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Z 5:.? Zo?\ <br />Inspectors Name :l-zoSG G!, 1k Date: <br />NPDES ID. No.:CO-0000213 Date Last Inspected: VS <br />Facility Configuration: Cross Valley Pond <br />Site Name: Impoundment #007 Location:46N15W SEC 6 <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) Q No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan CYe? No N/A <br />4. Burning (specify extend and location) Yes QD 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 Q N/A <br /> b.) At isolated points on embankment slopes: Yes Qi- 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 stream or ponded water Yes qz 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/A <br />10. Major erosion problems Yes N/A <br />il. Surface movements in :alley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes N/A <br />13. Water impounded against toe Yes M? N/A <br />14. Existing embankment freeboard (feet) 5(.4rA 2. s(e Ark 2 -?.C-3 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N 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 ® N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ® N/A <br /> b) Decant system Yes ® N/A <br />19. Trash racks clear and in place <:Ce,3 No N/A <br />?a+nt?e 15 ??$G1rtoe4??? <br />F:\Eng\DATP_\WP\pond-banks\DAMFOP.M.wpd <br />Z S??? -L-0 \\