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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : 5 cl \o Date: Z .ela- ?sa\k <br />NPDES ID. NO.:CO-0000213 Date Last Inspected: Z :Z <br />??0 2A 41 <br />-P. V-6- <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 N/A <br /> c) At natural hillside: Yes N? N/A <br /> d) Over widespread areas Yes (0 N/A <br /> e) From downsteam foundation area Yes (W N/A <br /> f) "Boils" beneath stream or ponded water Yes CID N/A <br />7. Cracks or scarps on crest Yes QD N/A <br />8. Cracks or scraps on slope Yes (M N/A <br />9. Sloughing or bulging on slope Yes cm?) N/A <br />10. Major erosion problems Yes (Z> N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes 4= N/A <br />13. Water impounded against toe Yes N/A <br />14. c <br />Existing embankment freeboard (feet) 5&a2. 3 - 5597_5 Fr a 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 0 N/A <br /> b) Decant system Yes <V N/A <br /> C) Diversion Ditches Yes N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes i N/A <br /> b) Decant system Yes N/A <br />19. Trash racks clear and in place 0 No N/A <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 />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) (?Pl No N/A <br />t37 na? J"0S OV?% n:?r <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />ZS7- Z.01