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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Odra <br />Mine ID No.: CDMG Permit #0008-81 <br />Owne rs 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 (Za 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 (D N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes ` Y N/A <br /> d) over widespread areas Yes Q 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 Q? N/A <br />13. water impounded against toe Yes ® N/A <br />14. Existing embankment freeboard (feet) 55(x`, ..5( ? , 7- Feet <br />is. Cracks, bulging, or erosion on upsteam face Yes (Z) N/P. <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 (D N/A <br /> c) Diversion Ditches Yes Q+ 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 (5D No N/A <br />Inspectors Name : ?oa5 Gy?pko, Date: -z- -2 ?t <br />NPDES ID. No.:CO-0000213 Date Last Inspected: "Lb <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #0013 Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />1-5 C? 1S"Z4Sa?Pj t <br />W aIV-4-t %6 V%4 mw ?r ?o w r n? x n- z %*-? 01-3 <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />Z 7z, rte... "7 a l \