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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: 3 ZaSS GV Date: 14- V-Rb -IszkL <br />NPDES ID. No.:CO- 0000213 Date Last Inspected: nloQ <br />Facility Configuration: Cross Valley Pond <br />Site Name: Impoundment #007 Location:46N15W SEC 6 <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) Ie 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 CO 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 (21, N/A <br />b.) At isolated points on embankment slopes: Yes ® N/A <br />c) At natural hillside: Yes Ci N/A <br />d) Over widespread areas Yes 1W4 N/A <br />e) From downsteam foundation area Yes I0 N/A <br />f) "Boils" beneath stream or ponded water Yes CIIN 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 CM N/A <br />11. Surface movements in valley bottom or on hillside Yes ett N/A <br />12 Erosion of toe Yes ® N/A <br />13. Water impounded against toe Yes ID N/A <br />14. Existing embankment freeboard (feet) 5445 L ^5`3v.? /1,5 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N/A <br />16. Visible sumps or sinkholes in slurry surface Yes CP N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes N/A <br />b) Decant system Yes CZ, 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 © No N/A <br />�eMd if , It G7':rchr,3' <br />F: \Eng \DATA \WP \pond- banks \DAMFORM.wpd <br />/4 4d /104- <br />