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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : ?as5 ?„?vk4 <br />NPDES ID. No.:CO-0000213 <br />Date: Z Zzg?jvlft. -L%\\ <br />Date Last Inspected: Zg ? ZmL` <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #011 Location:46N16W SEC 1 <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 Q No N/A <br />4. Burning (specify extend and location) Yes No 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 ® 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 ® 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 />11. Surface movements in valley bottom or on hillside Yes ® N/A <br />12. Erosion of toe Yes CD N/A <br />13. Water impounded against toe Yes ® N/A <br />14. Existing embankment freeboard (feet)_ lq p ?5?dD?. -10 Feet <br />15. 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 ® N/A <br /> b) Decant system Yes (c N/A <br /> c) Diversion Ditches Yes <DN N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes N/A <br /> b) Decant system Yes ®1 N/A <br />19. Trash racks clear and in place No N/A <br />-POY?CN \nGS Ao W V1 'ft YZ-00.4. A T?s <br />Vn J 10-01, 41 <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br /> <br />p.,. J\ 013