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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : 1 55 Gv?tj?Zq Date: Z <br />NPDES ID. No.:CO-0000213 Date Last Inspected: cc,,,S-kv, ?i y\ <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #0015 Location:47N 16W SEC 36 <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) Yes No <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan Yes No N/ <br />4. Burning (specify extend and location) Yes No <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 No QD <br /> b.) At isolated points on embankment slopes: Yes No N/A <br /> c) At natural hillside: Yes Qj) 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 />il. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes dl;> N/A <br />13. Water impounded against toe Yes (D N/A <br />14. Existing embankment freeboard (feet) 5S"I (.G - SSSg.0 17-43 Feet <br />is. Cracks, bulging, or erosion on upsteam face <br />Yes <br />N/A <br />16. visible sumps or sinkholes in slurry surface Yes ® N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes No <br /> b) Decant system Yes No <br /> c) Diversion Ditches Yes No T( <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes No <br /> b) Decant system Yes No ? <br />; <br />19. Trash racks clear and in place Yes No rrr( <br />---????,? <br />Q:J <br />cA, w. <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />A