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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : ??55 Gv?a Date : <br />NPDES ID. No.:CO-0000213 Date Last Inspected: ZS IF-o.,No 2,01 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location: 47N16W SEC 36 <br /> <br />Mine Name: New Horizon Mine Location: l mi.NW of Nucla, CO. <br /> <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) Ye 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 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 N/A <br /> b.) At isolated points on embankment slopes: Yes (ED N/A <br /> c) At natural hillside: Yes ® N/A <br /> d) Over widespread areas Yes 40 N/A <br /> e) From downsteam foundation area Yes ® N/A <br /> f) "Boils" beneath stream or ponded water Yes (M 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 (ZED N/A <br />11. Surface movements in valley bottom or on hillside Yes QD? N/A <br />12. Erosion of toe Yes Q?, N/A <br />13. Water impounded against toe Yes ® N/A <br />14. / <br />Existing embankment freeboard (feet) 51n ?-q q 5(039 0.S 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 Q? N/A <br /> b) Decant system Yes dD 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 No N/A <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />