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F: \Eng \DATA \WP \pond- banks \DAMFORM.wpd <br />Inspectors Name: l s G,00k0, <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Date: - i t4 v 'Z2, ll <br />NPDES ID. No.:CO - 0000213 Date Last Inspected: 31 p„ \ 1.0 <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #011 Location:46N16W SEC 1 <br />Mine Name: New Horizon Mine Location:1 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) Y a No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan a) 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 0. 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 C14 N/A <br />8. Cracks or scraps on slope Yes , N/A <br />9. Sloughing or bulging on slope Yes CO N/A <br />10. Major erosion problems Yes Or N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes ® N/A <br />13. Water impounded against toe Yes ® N/A <br />14. Existing embankment freeboard (feet) J Q — !R <br />1,423 $ (? 3 ,�, Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes (EP N/A <br />16. Visible sumps or sinkholes in slurry surface Yes CZYt N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes Ig N/A <br />b) Decant system Yes N/A <br />c) Diversion Ditches Yes <Z> 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 />JN't yt-e.. 0 t- S 'nom vie bra cr.�4. k�e� g�, SE CoY roa.- <br />