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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name :Jess &4b Q, <br />NPDES ID. No.:CO-0000213 <br />Date: Z.... 5.,. I'm ?.sQ V\ <br />Date Last Inspected: L$ <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #008 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) CD No N/A <br />2 <br />3 <br />4 <br />S <br />6 <br />7. <br />8. <br />9. <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />18 <br />19 <br />Lift thickness (inches) <br />Compaction according to approved plan (Zi No <br />Burning (specify extend and location) Yes <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: Yes <br />b.) At isolated points on embankment slopes: Yes (ED <br />c) At natural hillside: Yes <br />d) Over widespread areas Yes <br />e) From downsteam foundation area Yes 0 <br />f) "Boils" beneath stream or ponded water Yes <br />Cracks or scarps on crest Yes G <br />Cracks or scraps on slope Yes <br />Sloughing or bulging on slope Yes ®+ <br />Major erosion problems Yes <br />Surface movements in valley bottom or on hillside Yes <br />Erosion of toe Yes <br />Water impounded against toe Yes <br />Existing embankment freeboard (feet) T&55.3 -55ZO-S -1S <br />Cracks, bulging, or erosion on upsteam face Yes <br />visible sumps or sinkholes in slurry surface Yes <br />Clogging <br />a) Spillway channels and pipes Yes Q5? <br />b) Decant system Yes <br />c) Diversion Ditches Yes <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes ?L <br />b) Decant system Yes ??Tp? <br />Trash racks clear and in place (a No <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/P. <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.v,pd <br />h0-? C? 'S"aTS-Vt <br />